PAIN MANAGEMENT: EFFECT OF CHEWING EXERCISES IN POST TONSILLECTOMY PATIENTS
Main Article Content
Objective: To assess the effect of chewing in addition to pharmacological management of post-tonsillectomy pain and return to the normal diet.
Methodology: To determine the impact of chewing gum on post-operative pain, a 12-month comparative cross-sectional study was carried out on 87 post-tonsillectomy patients at the Pakistan Institute of Medical Sciences (PIMS) Islamabad. Two groups of patients having elective tonsillectomy were created: Group A (chewing gum) and Group B. (routine care). Following surgery, patients were monitored to assess postoperative pain using a Visual Analogue Scale (VAS) from day 1 to day 7 and resume their regular diet.
Results: Out of 87 patients, 49 (56.3%) belonged to group A, and 38 (43.7%) belonged to group B. Mean age of the participants was 23.8±5.2 years. The total number of male and female participants was 56 (64.4%) and 31 (35.6%) respectively. There was significantly lesser pain experienced by patients in group A as compared to group B from day 2 through day 5 (p<0.001), whereas there were no statistically significant differences observed between the two groups on the 1st,6th and 7th post-operative days in terms of post-op pain (p=0.589, 0.516, 0.376). In terms of resuming a normal diet, there was no statistically significant difference between the two groups. (p= 0.456).
Conclusion: Postoperative use of chewing exercises significantly decreases pain in the immediate post-tonsillectomy period and is recommended for use as a non-pharmacological adjunct for post-tonsillectomy pain management.
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Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. 2019;160(1_suppl):S1-S42. DOI:10.1177/0194599818801757.
Anderson J, Paterek E. Tonsillitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Available from URL: https://www.ncbi.nlm.nih.gov/ books/NBK544342/
Greig SR. Current perspectives on the role of tonsillectomy. J Paediatr Child Health. 2017;53(11):1065-70. DOI:10.1111/jpc.13745.
Ghufoor K, Frosh A, Sandhu G, Hanif J. Post-tonsillectomy patient care in the community. Int J Clin Pract. 2000;54(7):420-3. PMID: 11070564.
Moir MS, Bair E, Shinnick P, Messner A. Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy. Laryngoscope. 2000;110(11):1824-7. DOI:10.1097/00005537-200011000- 00011.
Cohen N, Sommer DD. Post-tonsillectomy pain control: consensus or controversy? Pain Manag. 2016;6(1):31-7. DOI: 10.2217/pmt.15.58.
Hasnain F, Janbaz KH, Qureshi MA. Analgesic effect of ketamine and morphine after tonsillectomy in children. Pakistan journal of pharmaceutical sciences. Pak J Pharm Sci. 2012;25(3):599-606.
Jensen DR. Pharmacologic management of post-tonsillectomy pain in children. World J Otorhinolaryngol Head Neck Surg. 2021;7(3):186-93. DOI:10.1016/j.wjorl.2021.03.004.
Voutilainen A, Pitkäaho T, Kvist T, Vehviläinen-Julkunen K. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. J Adv Nurs. 2016;72(4):946-57. DOI:10.1111/ jan.12875.
Gabrawi M, Haymes A, Davis J. Post-tonsillectomy advice: the UK patient experience. J Laryngol Otol. 2022;136(12):1217-25. DOI:10.1017/ S0022215121004527.
Schiff M. Chewing gum and tonsillectomy. The Laryngoscope. 1982;92(7 Pt 1):820. DOI: 10.1288/00005537- 198207000-00022.
Hanif J, Frosh A. Effect of chewing gum on recovery after tonsillectomy. Auris Nasus Larynx. 1999;26(1):65-8. DOI:10.1016/s0385-8146(98)00046- 7.
Schaler R, Parkin JL. Perioperative nutritional considerations in the tonsillectomy patient. Otolaryngol Clin North Am. 1987;20(2):345-7.