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CC BY 4.0 · Int Arch Otorhinolaryngol 2024; 28(03): e440-e450
DOI: 10.1055/s-0043-1777295
Original Research

Posttonsillectomy Pain Relief and Wound Healing by Applying Bismuth Iodoform Paraffin Paste (BIPP) to Dissected Tonsillar Beds

Rahimah Idris
1   Department of Otorhinolaryngology, Head and Neck Surgery, Pantai Hospital Laguna Merbok, Bandar Laguna Merbok, Sungai Petani, Kedah, Malaysia
,
Ramiza Ramza Ramli 
2   Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
,
Wan NorSyafiqah W Yaacob
2   Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
,
Shahid Hassan 
3   International Medical University (IMU) Centre for Education, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
› Author Affiliations Funding The authors declare that they have received no financial support from agencies in the public, private or non-profit sectors to conduct the present research.
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Abstract

Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma.

Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties.

Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated.

Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days (p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14.

Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy.

Keywords

palatine tonsil - tonsillectomy - pain - wound healing - bismuth paste


Publication History

Received: 11 April 2023

Accepted: 15 October 2023

Article published online:
19 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Bitar MA, Dowli A, Mourad M. The effect of tonsillectomy on the immune system: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2015; 79 (08) 1184-1191
    CrossrefPubMedSearch in Google Scholar
  • 2 Álvarez Palacios I, González-Orús Álvarez-Morujo R, Alonso Martínez C, Ayala Mejías A, Arenas Brítez O. Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?. Indian J Otolaryngol Head Neck Surg 2017; 69 (02) 187-193
    CrossrefPubMedSearch in Google Scholar
  • 3 Gettis M, Brown AM, Fujimoto A, Wetzel M, Thomsen J. Gabapentin Premedication to Reduce Postoperative Pain for Pediatric Tonsillectomy/Adenoidectomy: A Pilot Study. J Perianesth Nurs 2022; 37 (05) 626-631
    CrossrefPubMedSearch in Google Scholar
  • 4 Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. PROSPECT Working Group collaborators*. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 76 (07) 947-961
    CrossrefPubMedSearch in Google Scholar
  • 5 Carpenter P, Hall D, Meier JD. Postoperative care after tonsillectomy: what's the evidence?. Curr Opin Otolaryngol Head Neck Surg 2017; 25 (06) 498-505
    CrossrefPubMedSearch in Google Scholar
  • 6 Guntinas-Lichius O, Geißler K, Preußler NP, Meißner W. Optimale Schmerztherapie nach Tonsillektomie: ein ungelöstes Problem. [Optimal Postoperative Pain Management After Tonsillectomy: An Unsolved Problem] Laryngorhinootologie 2016; 95 (01) 15-23
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Hui D, Søvik S. Postoperative pain course after paediatric tonsillectomy: A prospective observational study comparing one behavioural and one numerical pain assessment tool. Int J Pediatr Otorhinolaryngol 2020; 138: 110395
    CrossrefPubMedSearch in Google Scholar
  • 8 Choi KY, Ahn JC, Rhee CS, Han DH. Intrapatient Comparison of Coblation versus Electrocautery Tonsillectomy in Children: A Randomized, Controlled Trial. J Clin Med 2022; 11 (15) 4561
    CrossrefPubMedSearch in Google Scholar
  • 9 Regmi D, Bista M, Shrestha S. Comparison of Clinical and Functional Outcome of Cold Steel Dissection versus Coblation Technique in Tonsillectomy. J Nepal Health Res Counc 2022; 19 (04) 820-823
    PubMedSearch in Google Scholar
  • 10 Cai Y, Lopata L, Roh A. et al. Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients. J Clin Anesth 2017; 39: 100-104
    CrossrefPubMedSearch in Google Scholar
  • 11 Ortega B, Stramiello JA, Brigger M, Nation J. Anesthetic injections and analgesia use in pediatric post-tonsillectomy patients: A meta-analysis and systematic review. Int J Pediatr Otorhinolaryngol 2022; 152: 110976
    CrossrefPubMedSearch in Google Scholar
  • 12 Jensen DR. Pharmacologic management of post-tonsillectomy pain in children. World J Otorhinolaryngol Head Neck Surg 2021; 7 (03) 186-193
    CrossrefPubMedSearch in Google Scholar
  • 13 Akural EI, Koivunen PT, Teppo H, Alahuhta SM, Löppönen HJ. Post-tonsillectomy pain: a prospective, randomised and double-blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique. Anaesthesia 2001; 56 (11) 1045-1050
    CrossrefPubMedSearch in Google Scholar
  • 14 Jotić A, Savić Vujović K, Milovanović J. et al. Pain Management After Surgical Tonsillectomy: Is There a Favorable Analgesic?. Ear Nose Throat J 2019; 98 (06) 356-361
    CrossrefPubMedSearch in Google Scholar
  • 15 Lee AC, Haché M. Pediatric Anesthesia Management for Post-Tonsillectomy Bleed: Current Status and Future Directions. Int J Gen Med 2022; 15: 63-69
    CrossrefPubMedSearch in Google Scholar
  • 16 Wall JJ, Tay KY. Postoperative Tonsillectomy Hemorrhage. Emerg Med Clin North Am 2018; 36 (02) 415-426
    CrossrefPubMedSearch in Google Scholar
  • 17 Xu B, Jin HY, Wu K. et al. Primary and secondary postoperative hemorrhage in pediatric tonsillectomy. World J Clin Cases 2021; 9 (07) 1543-1553
    CrossrefPubMedSearch in Google Scholar
  • 18 Kim SJ, Walsh J, Tunkel DE, Boss EF, Ryan M, Lee AH. Frequency of post-tonsillectomy hemorrhage relative to time of day. Laryngoscope 2020; 130 (07) 1823-1827
    CrossrefPubMedSearch in Google Scholar
  • 19 Chen MM, Roman SA, Sosa JA, Judson BL. Safety of adult tonsillectomy: a population-level analysis of 5968 patients. JAMA Otolaryngol Head Neck Surg 2014; 140 (03) 197-202
    CrossrefPubMedSearch in Google Scholar
  • 20 Gurd FB, McKim LHBIPP. B.I.P.P. AND LIQUID PARAFFIN TREATMENT OF WAR AND CIVILIAN WOUNDS. Ann Surg 1941; 113 (06) 987-1000
    CrossrefPubMedSearch in Google Scholar
  • 21 Chrintz H, Vibits H, Cordtz TO, Harreby JS, Waaddegaard P, Larsen SO. Need for surgical wound dressing. Br J Surg 1989; 76 (02) 204-205
    CrossrefPubMedSearch in Google Scholar
  • 22 Athanikar Narayan Krishnarao. Bismuth-containing compounds in topical dosage forms. World Intellectual Property Organization Publ. of the Int. Appl. with search report - European Patent Office. 1996 Dec 19. WO 1996/40552
  • 23 Fortier MA, MacLaren JE, Martin SR, Perret-Karimi D, Kain ZN. Pediatric pain after ambulatory surgery: where's the medication?. Pediatrics 2009; 124 (04) e588-e595
    CrossrefPubMedSearch in Google Scholar
  • 24 Rømsing J, Ostergaard D, Drozdziewicz D, Schultz P, Ravn G. Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients. Acta Anaesthesiol Scand 2000; 44 (03) 291-295
    CrossrefPubMedSearch in Google Scholar
  • 25 Millington AJ, Phillips JS. Current trends in tonsillitis and tonsillectomy. Ann R Coll Surg Engl 2014; 96 (08) 586-589
    CrossrefPubMedSearch in Google Scholar
  • 26 Møiniche S, Rømsing J, Dahl JB, Tramèr MR. Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 2003; 96 (01) 68-77
    CrossrefPubMedSearch in Google Scholar
  • 27 Junaid M, Halim MS, Onali MAS, Qadeer S, Khan HU, Ali NS. Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial. Int Arch Otorhinolaryngol 2020; 24 (01) e62-e67
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Lubis AS, Herwanto HRY, Rambe AYM. et al. The effect of honey on post-tonsillectomy pain relief: a randomized clinical trial. Rev Bras Otorrinolaringol (Engl Ed) 2023; 89 (01) 60-65
    CrossrefPubMedSearch in Google Scholar
  • 29 Ozlugedik S, Genc S, Unal A, Elhan AH, Tezer M, Titiz A. Can postoperative pains following tonsillectomy be relieved by honey? A prospective, randomized, placebo controlled preliminary study. Int J Pediatr Otorhinolaryngol 2006; 70 (11) 1929-1934
    CrossrefPubMedSearch in Google Scholar
  • 30 Van Elstraete AC, Lebrun T, Sandefo I, Polin B. Ketamine does not decrease postoperative pain after remifentanil-based anaesthesia for tonsillectomy in adults. Acta Anaesthesiol Scand 2004; 48 (06) 756-760
    CrossrefPubMedSearch in Google Scholar
  • 31 Vaiman M, Eviatar E, Shlamkovich N, Segal S. Effect of modern fibrin glue on bleeding after tonsillectomy and adenoidectomy. Ann Otol Rhinol Laryngol 2003; 112 (05) 410-414
    CrossrefPubMedSearch in Google Scholar
  • 32 Rhendra Hardy MZ, Zayuah MS, Baharudin A. et al. The effects of topical viscous lignocaine 2% versus per-rectal diclofenac in early post-tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol 2010; 74 (04) 374-377
    CrossrefPubMedSearch in Google Scholar
  • 33 Akbas Y, Pata YS, Unal M, Gorur K, Micozkadioglu D. The effect of fusafungine on post-operative pain and wound healing after pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 2004; 68 (08) 1023-1026
    CrossrefPubMedSearch in Google Scholar
  • 34 Davidoss NH, Eikelboom R, Friedland PL, Santa Maria PL. Wound healing after tonsillectomy - a review of the literature. J Laryngol Otol 2018; 132 (09) 764-770
    CrossrefPubMedSearch in Google Scholar
  • 35 Murray AD, Gibbs SR, Billings KR, Biavati MJ. Respiratory difficulty following bismuth subgallate aspiration. Arch Otolaryngol Head Neck Surg 2000; 126 (01) 79-81
    CrossrefPubMedSearch in Google Scholar