Comparative study of the analgesic profiles of a new intravenous paracetamol preparation, ketorolac, and their combination in day case otorhinolaryngologic surgeries

This study was done on 60 adult patients who had day case otorhinolarngologic surgeries. Patients were allocated into three groups, according to perioperative analgesic used: Group 1 [n =20] was given 30 mg ketorolac IV, Group 2 [n=20] was given a new solubilised paracetamol formulation [Perfalgan 10mg/mi] 1gm IV infusion, and Group 3 [n=20] was given 30mg ketorolac IV plus Perfalgan 1gm IV infusion. Analgesic profiles were evaluated using the sum of pain intensity difference after 6 and 12 hours of drug intake [SPID[6and12]], the total pain relief score after 6 and 12 hours of drug intake [TOTPAR[6and12]], global patient satisfactionwith pain control, and use of rescue analgesics. Surgeons' satisfaction with intraoperative bleeding and surgical field, in addition to bleeding time were also studied as indications of tolerability to the drugs. This study demonstrated no significant differences in pain scores between ketorolac and Perfalgan, while SPID[6and12] and TOTPAR[6and12] were significantly higher in the combination group [11.6 +/- 2.1 and 20.2 +/- 4.5, p=0.01 and 0.022 respectively for SPID[6and12] and 19.6 +/- 6.2 and 39.3 +/- 8.6, p=0.001 and 0.003 respectively for TOTPAR[6and12] indicating much less pain intensity and better pain relief with the combination. In addition, fewer patients in the combination group required rescue pethidine, while no significant difference was detected in the use of rescue pethidine between the other two groups. Fourteen patients in the combination group rated their satisfaction for the analgesic regimen as very good to excellent, while only one patient in the ketorolac group had a very good response, and none of the Perfalgan group had a very good to excellent response. Surgeons' satisfaction with intraoperative surgical bleeding and surgical field was satisfactory to excellent in all groups. In addition, postoperative bleeding times in all groups did not show any significant prolongation 12 hours after discharge from recovery room. This study has demonstrated that the use of a combination of paracetamol IV infusion in the new formulation known as 'Perfalgan' Ig and IV ketorolac 30mg for control of postoperative pain in day case otorhinologic surgeries was efficient and enough to avoid the use of additional narcotics, and had a better analgesic efficacy than either drug alone, without any significant side effects on intraoperative or postoperative surgical bleeding

Spreader graft placement as a treatment for internal nasal valve in insufficiency

The objective of this study was to evaluate and describe the results of the surgical procedures to treat internal nasal valve insufficiency by using spreader grafts placed via an external approach of rhinoplasty. Thirty-five patients with complaints of nasal obstruction, in part due to internal nasal valve insufficiency, underwent this operation on 63 sides in a private practice setting. Only autologous material was used. The technique of insertion of spreader graft between the upper lateral cartilage and the septum was done through an external rhinoplasty approach. All patients were prospectively studied and subjective self-assessment was judged to quantify the result of the operation. On 47 sides, nasal breathing was described as "optimal" and on 13 sides, the result was described as "improved". On two sides, no change was noted and on one side, the postoperative situation was judged worse

Middle turbinate lateralization under local anesthesia: a simple technique for treatment of middle turbinate headache syndrome

Middle turbinate headache syndrome is a rare, but not uncommon, treatable cause of headache. It is described as the compression of the middle turbinate against the septum or the lateral wall of the nose and it is characterized by intermittent, usually unilateral, periorbital pain. The clinical history, nasal endoscopic examination and coronal CT scan should point towards the diagnosis and a local anesthetic challenge test should confirm the diagnosis. Treatment is by relieving the contact point by medical or surgical means. To study the effectiveness of a simple minimally invasive method for elimination of the symptoms of middle turbinate headache syndrome. A prospective study of 25 patients with chronic nasal or glabellar pain who endoscopically demonstrated a contact point between the middle turbinate and the nasal septum. All patients were treated by lateralization of the middle turbinate using a small metal instrument like a tongue depressor under 10% lidocaine HCL topical anesthesia. Of the treated cohort: 23 [92%] of the patients had complete clinical symptom resolution after one treatment and 2 patients [8%] had resolution after two treatments sittings. Recurrence occurred in 1 patient [4%] after 7 months of follow up. There were no short or long-term adverse sequelae. The results persisted at a mean follow-up time of 30 months [range, 7-36 months]. Middle turbinate lateralization under local anesthesia is a simple, safe and effective technique in eliminating the symptoms of rhinologic headache induced by a contact point between the middle turbinate and nasal septum