BACKGROUND

In recent years, the Health Companies, with the aim of reducing costs, have supported the Week Surgery organizational model. This model was also introduced in the Otorhinolaryngology Department S.C. the A.O.U. City of Health and science of Turin, Molinette Hospital. It was made a multidisciplinary team to improve clinical outcomes and reduce recovery times. This group consist of anesthesiologists, nurses and otolaryngologist. The resulting team developed several protocols, including one related to pain management. With the aim of evaluate the efficacy of the analgesic protocol, was made an observational study.

METHODS

From 1 January 2018 to 31 December 2022, 450 patients (200 men and 250 women) aged between 20 and 65 years were observed. It was divided as follows:

• Myringoplasty: 36 men / 49 women
• FESS (Functional Endoscopic Sinus Surgery): 60 men / 69 women
• Septoplasty: 65 men / 78 women
• Tympanoplasty: 33 men / 45 women
• Rhinoseptoplasty: 6 men / 9 women

Post – operative analgesia:

• Upon awakening: loading dose with Tramadol 1,5 mg/kg – Paracetamol 1 g – Metoclopramide 10 mg
• Postoperative: Intravenous Tramadol 200 mg in 500 ml of saline solution at 63 ml/h
• Rescue Dose: Intravenous Tramadol 50 mg in 100 ml of saline solution at 400 ml/h if Visual Analogue Scale (VAS) > 3

Assessed parameters:

• Average pain by type of surgery
• Nausea and vomit
• Cumulative percent of pain
• Number of Rescue Dose administered
• Average pain men and women
• Percent patients discharged within the postoperative first day of the total patients observed

Method of data collection

The detection of pain with VAS scale was made as follows: time zero, after 4 hours, after 10 hours, after 20 hours (discharge). If the patient reported pain VAS > 3, the rescue dose was administered and the pain was assessed after 1 hour.

RESULTS

Myringoplasty: VAS = 0,54 – FESS: VAS = 1,06 – Septoplasty: VAS = 0,82

Tympanoplasty: VAS = 1,14 – Rhinoseptoplasty: VAS = 2,16 – Nausea: 7 % - Vomiting: 5 %

Rescue Dose: no administration: 90 % - one administration: 9 % - two administrations: 0 %

Average VAS men: 1,44 – Average VAS women: 1,25

Cumulative percent: VAS 0 = 62,7 % - VAS 1 = 12,2% - VAS 2 = 10% - VAS 3 = 8,6% - VAS 4 = 1,4% - VAS 5 = 1,6% - VAS 6 = 1,3% - VAS 7 = 0,5% - VAS 8 = 0,4% - VAS 9 = 0,2% - VAS 10 = 0%

VAS not assessable: 0.8%

Discharged on the first postoperative day: 6,6 % (420/450)

CONCLUSIONS

The analgesic protocol proved to be effective and safe. The pain was VAS < 3 in the 20 hours postoperative, such as nausea and vomiting, occurred in unimportant percentages. Thanks also to the good pain control, the patients were able to eat and move early from the bed with a rapid recovery and full autonomy.

REFERENCES

1. Chorath K, Hobday S, Suresh NV, Go B, Moreira A, Rajasekaran K. Enhanced recovery after surgery protocols for outpatients operations in otolaryngology: Review of literature. World Journal of Otorhinolaryngology – Head and neck Surgery; 2022; 8 (2):96-106.
2. Klimczak J, Badhey A, Wong A, Colley P, Teng M. Pain management and prescribing practice in otolaryngology residency programs. American Journal of Otolaryngology; 2020; 41 (1):102265