Percutaneous Peristyloid Glossopharyngeal Block After Tonsillectomy

Study Overview
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Brief Summary
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Adenotonsillectomy surgery in paediatrics is commonly managed as an ambulatory surgery. This may be attributed to the use of the electro-dissection surgical technique that decreases the incidence of immediate postoperative haemorrhage. However, the use of the electro-cautery technique increases postoperative inflammation. This study aimed to compare the glossopharyngeal nerve block using the blind technique with the use of the ultrasound guidance Primary: FLACC score in the two groups 0,2,4,6 h after surgery at rest and with swallowing Secondary: need to analgesics, the difficulty of the technique, time consumption, recovery time, surgeon satisfaction, parents satisfaction, staff nurse satisfaction, anaesthetist self-confidence

Detailed Description
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INTRODUCTION Adenotonsillectomy surgery in paediatrics is commonly managed as an ambulatory surgery. This may be attributed to the use of the electro-dissection surgical technique that decreases the incidence of immediate postoperative haemorrhage. However, the use of the electro-cautery technique increases postoperative inflammation. Sensory fibres of the glossopharyngeal nerve supply the tonsillar and peri-tonsillar areas. Thus, a bilateral glossopharyngeal nerve block may alleviate post-tonsillectomy pain and improve postoperative analgesia. This is a Prospective randomized controlled clinical study, to compare two different technique used to block the glossopharyngeal nerve. AIM OF WORK To improve post tonsillectomy pain control in children Anaesthesia, postoperative analgesia Paediatrics 3-7 years Tonsillectomy NOT adenotonsillectomy Postoperative control of pain OBJECTIVES This study aimed to compare the glossopharyngeal nerve block using the blind technique with the use of the ultrasound guidance Primary: FLACC score in the two groups 0,2,4,6 h after surgery at rest and with swallowing Secondary: need to analgesics, the difficulty of the technique, time consumption, recovery time, surgeon satisfaction, parents satisfaction, staff nurse satisfaction, anaesthetist self-confidence METHODOLOGY 54 ASA I children allocated randomly into two groups: Group BL: Blind percutaneous peristyloid injection Group US: ultrasound-guided percutaneous peristyloid glossopharyngeal nerve block 54 children aged 3 to 7 years undergoing adenotonsillectomy without adenoidectomy were randomized to receive either local blind percutaneous peistyloid glossopharyngeal nerve block (n=27) or the use of ultrasound guidance for the same block (n=27). The pain was assessed by the FLACC scale or Face, Legs, Activity, Cry, Consolability scale, need for analgesics, and acceptance of diet during the postoperative period.

Official Title
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Comparison Between Two Techniques of Percutaneous Peristyloid Glossopharyngeal Block as an Analgesic Tool After Tonsillectomy

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: glossopharyngeal nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: children aged 3-7 years scheduled for tonsillectomy Exclusion Criteria: younger or elder children associated adenoidectomy history of allergy to local anaesthetics

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 7 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: two groups, each will have peristyloid glossopharyngeal block, one with the help of ultrasound technology and the other blindly
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: blind glossopharyngeal nerve block<br>patients will have the glossopharyngeal nerve block with the blind technique | Procedure: glossopharyngeal nerve block<br>* glossopharyngeal nerve block either blindly or using the ultrasonic technique<br>|
| Active Comparator: ultrasonic glossopharyngeal nerve block<br>patients will have the glossopharyngeal nerve block using the ultrasonic technique | Procedure: glossopharyngeal nerve block<br>* glossopharyngeal nerve block either blindly or using the ultrasonic technique<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in face, legs, activity, cry, and consolability (FLACC) score | FLACC is a behavioural pain assessment scale used for nonverbal or preverbal patients who cannot self-report their pain level. Pain is assessed through observation of 5 categories including the face, legs, activity, cry, and consolability. The scale ranges from 0 to 10 where 0 records for no pain and 10 records for the worst pain | Immediately postoperatively considered as 0 hour, then at 2 hours, again at 4 hours, and lastly at 6 hours after surgery all measures will be both at rest and with swallowing | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| need for postoperative analgesia | need to analgesics in doses and frequencies both at rest and with swallowing. | immediately postoperatively considered as 0 hour, then at 2 hours, again at 4 hours, and lastly at 6 hours after surgery | 
| difficulty of the technique | prescribed by the operator either easy or difficult | immediately after the intervention | 
| time consumption | from the start of preparation of the procedure, till the end of the block time in minutes | immediately after the intervention | 
| recovery time | from the end of the surgery, till shifting the patient from operation table to recovery bed time in minutes | immediately before shifting the patient to recovery room | 
| surgeon satisfaction assessed by visual analogue scale (VAS) | described by the surgeon him self on a scale ranging from very satisfactory to unsatisfactory | immediately after discharging the patient to home | 
| anesthetists self-confidence | described as yes or no | immediately after the intervention | 
| parents satisfaction | described by the parents on a scale ranging from very satisfactory to unsatisfactory | immediately before discharging the patient to home | 
| staff nurse satisfaction | described by the recovery nurse and daycare unite nurse on a scale ranging from very satisfactory to unsatisfactory | immediately before shifting the patient from the recovery room to the day care unite by recovery nurse, and immediately after discharging the patient to home by daycare unite nurse | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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analgesia, tonsillectomy