Written by Peter-John Wormald, the richly illustrated text details anatomy and operative treatment of sinonasal conditions such as nasal polyposis, chronic rhinosinusitis CRSSamter's triad, eosinophilic mucus CRS, exophthalmos, acute orbital hemorrhage, orbital subperiosteal abscess, and a wide array of tumors.
Find articles by Chethan M. Find articles by Sheetal D. Intravenous iv paracetamol provides pain relief in most patients who have undergone FESS.
In some studies, it was found to be inadequate. It has been observed from previous studies conducted on patients undergoing other surgeries like abdominal surgeries that the analgesic efficacy of iv paracetamol improves when used Pre-emptively.
The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous iv paracetamol in FESS. Following institutional ethics committee approval, thirty nine American Society of Anesthesiology ASA physical status I-II patients were assigned in a randomized manner into two groups: Group I received iv paracetamol 1g, in mL, 15 minutes before induction and Group II received iv paracetamol 1g, in mL, at the end of the surgery.
The time to first analgesic use and the total analgesic consumed in 24 hours was recorded. Visual Analog Scale VAS pain scores were obtained from all patients at 0, 30 minutes, 1, 2, 6, 12 and 24 hours after the end of the Surgery.
Pre-emptive iv paracetamol in comparison to intra-operative paracetamol, provided effective and reliable post-operative analgesia after FESS.
The goal of this procedure is to restore the sinus ventilation and normal function [ 1 ]. Though minimally invasive, the surgery is associated with mild to moderate post-operative pain, which is related to both surgical trauma and nasal packing [ 2 ].
Routine analgesic treatment is usually based on non-opioid analgesics with rescue opioids [ 3 ]. Pre-emptive pain control is where, regional or systemic analgesics are applied before the start of the surgical procedure.
The affect is achieved by suppressing, either together or separately, central or peripheral sensitization. Pre-emptive analgesia gives rise to a subsiding pain model, a decrease in analgesic requirements, and a decline in morbidity, promoting wellness and shortening the length of hospital stays [ 4 — 6 ].
However, opinions on the utility of pre-emptive analgesia differ between observers [ 67 ]. Paracetamol acetaminophen; N-acetyl-p-aminophenol is one of the most regularly used drugs worldwide, attributable to an excellent safety profile of the drug.
The pre-emptive effect of intravenous paracetamol has been studied in various surgical procedures. While some are of the opinion that iv paracetamol is effective as a pre-emptive analgesic [ 9 ] others find no credibility [ 10 ]. Even though there are studies to show that intravenous paracetamol provides good analgesia in endoscopic sinus surgeries [ 11 — 13 ] there has been no study to study the pre-emptive effect of paracetamol in these surgeries.
The purpose of the present study was to determine the post-operative analgesic effects of pre-emptive iv paracetamol and the amount of reduction in tramadol consumption in FESS. Materials and Methods Ethical clearance was obtained by the ethical committee of the institution.
After obtaining written informed consent from each participant, 39 patients in the age group of 16 — 69 years, undergoing FESS, were enrolled. The inclusion criteria were ASA physical status I and II, not having any contraindications to the use of the study drug.
Patients were seen on the day before surgery and trained about the usage of the VAS for pain scores. The VAS represents the simple verbal scale and evaluates pain according to the following scores: Study Design The study was single centred, randomized, double-blind study.
The computer-generated block randomization schedule was prepared using random number generator to create a list of random numbers by a statistician.
A total of 2 anaesthetists were involved in the study. The attending anaesthesiologist was blinded to the patient grouping.
Anaesthetic technique was standardized. For induction and intubation, Patients were extubated when fully awake. VAS pain scores were recorded at 0, 30th minutes and 1, 2, 6, 12, 18, and 24 hours after the completion of surgery. Patients of both groups received iv tramadol 1.
The time for first analgesic requirement was noted. Total consumption of tramadol was noted. Side effects if any, such as nausea, vomiting, respiratory depression, itching, rash, allergic reaction and hypotensions were recorded. Statistical analysis was performed by using Medcalc Functional Endoscopic Evaluation of Swallow (FEES) he achieved his Certificate of Completion of Specialist Training in while working on his Master of Surgery thesis, based on the Nasal Research Clinic which he founded in LASER treatment for nasal blockage, polyps, functional endoscopic sinus surgery (FESS) and minimally.
Decision: Endoscopic septoplasty is an effectual technique that can be performed safely entirely or in combination with endoscopic fistula surgery with minimum extra morbidity. It provides important clinical and first-class learning tool when used in concurrence with video proctors over traditional attacks.
allowing surgery in the vicinity of the sella (8). Along the same line was the introduction of the endoscope into the sella, which was a spill-over from otorhinolaryngologists performing endoscopic sinus surgery, so called FESS surgery (functional endoscopic sinus surgery).
Some centres developed the. Who should attend? The course is of particular benefit and interest for residents, fellows and otorhinolaryngologists who developed some experience with basic endoscopic surgery of the paranasal sinuses and want to develop their skills.
Functional endoscopic sinus surgery (FESS). This utilizes a nasal endoscope to open the sinus pathways. A thin tube with a camera attached is inserted through the nose and obstructive tissue is .
Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 percent may be expected following the procedure.