Pre-emptive oral dextromethorphan reduces both postoperative and packing removal pain in patients undergoing nasal surgery

To determine whether premedication with 45 mg of oral dextromethorphan [DM] given 90 minutes prior to nasal surgery decreases postoperative pain and consequently reduces opioid administration and also, if it reduces the pain of pack removal. This was a prospective, double blind, randomized, controlled study carried out from January 2007 to March 2008 at Al-Moosa General Hospital, Al-Ahsa, Saudi Arabia, in which 38 patients received oral DM [age 28 +/- 11 years], and 38 patients received placebos [age 26 +/- 10 years]. Postoperative pain was assessed using a visual analog scale, and a pain score of > /-5 was treated by a rescue bolus dose of morphine sulfate 2 mg every 10 minutes in the post-anesthesia care unit [PACU] and by one gm of paracetamol in the surgical ward until the score became < 5. Pain was also assessed during pack removal. The placebo group had a higher pain score in the PACU, and hence a higher morphine consumption than the DM group [7.3 mg +/- 2.6 versus 4.6 mg +/- 1.2, p=0.03]. Pain score in the surgical ward was also higher in the placebo group at 4, 8, 12, and 24 hours, but this was insignificant, and was insignificantly lower only at 18 hours [p=0.26]. The placebo group had a higher pain score at pack removal than the DM group [7.8 +/- 11 versus 3.5 +/- 15, p=0.004]. Preemptive medication with DM reduces opioid administration in the early postoperative period and during pack removal

Sino-nasal epithelial tumours: a clinicopathological study

Epithelial neoplasms are uncommon lesions affecting the sino-nasal tract. To study the incidence, mode of presentation and histological types of sino-nasal epithelial tumours in the surgical pathology material and surgical procedures and outcome. All sino-nasal epithelial tumours, biopsied or surgically excised over a period of six years, were studied. The tumours were classified as benign or malignant. The histology was correlated with the clinical presentation, investigations, surgical procedures and outcome. In six years, there were 139 sino-nasal tumours. One-hundred one epithelial tumors [72.6%] outnumbered the nonepithelial tumours were diagnosed on the basis of histopathology. Forty-five were benign [44.5%] and 56 malignant [55.5%] occurring predominantly in males. Benign lesions included three fungiform papillomas [exophytic] [6.6% of the benign tumors] and 42 inverted papillomas, with recurrence in five inverted papillomas [11.9%]. Malignant changes were detected in two cases of inverted papilmours [4.8%] at initial surgery and in one of five recurrent cases [20%]. Endoscopic and external approaches were of equivalent results. Squamous cell carcinomas were the commonest among malignant tumours with thirty cases [53.2%] and three of these were associated with inverted papillo either synchronously or metachronously. The second most frequent malignant tumour was adenoid cystic carcinoma with twelve cases. Other rare types included the variants of squamous carcinoma, adenocarcinomas, muco-epidermoid carcinoma, and undifferentiated carcinomas. Smoking and environmental pollution were blamed as etiologic factors. Cases mostly presented in late stages. Multimodality treatment including surgery, radiotherapy and chemotherapy was the option to achieve optimal results but still with poor prognosis. Sino-nasal epithelial tumours are rare lesions, with male preponderance. Inverted papillomas and squamous cell carcinomas the most frequent neoplasms