{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T10:07:32Z","timestamp":1760609252799},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,3,31]],"date-time":"2020-03-31T00:00:00Z","timestamp":1585612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Post-tonsillectomy pain in adults can be severe and is often poorly controlled. Pain can lead to decreased oral intake, bleeding, longer hospital stays, emergency department visits, dehydration, and weight loss. Due to persistent pain despite scheduled medications, other methods for pain control are needed. Local\/regional anesthetic options have been previously studied in this population. Unfortunately, neither the injection of local anesthetics into the tonsillar fossa nor the postoperative topical application of local anesthetics to the tonsillar bed has demonstrated efficacy in large systematic reviews.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Here we report on the post-tonsillectomy pain experience of three patients who were treated with perioperative nerve blocks placed in the pterygopalatine fossa. This represents an as-yet unexplored option for post-tonsillectomy pain control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>After induction of general anesthesia, before surgical incision, a 25-gauge spinal needle was advanced into the pterygopalatine fossa using a suprazygomatic, ultrasound-guided approach. Ropivacaine and dexamethasone were deposited into the pterygopalatine fossa.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All three patients experienced excellent pain control for the duration of their recovery and required \u226410\u2009mg of oxycodone over the two weeks after surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our case series of three patients provides proof of concept that use of nerve blocks in the pterygopalatine fossa can be useful for the control of post-tonsillectomy pain. Further study is needed to confirm these initial results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnaa062","type":"journal-article","created":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T20:16:47Z","timestamp":1581538607000},"page":"2441-2446","source":"Crossref","is-referenced-by-count":9,"title":["Trigeminal Nerve Blockade in the Pterygopalatine Fossa for the Management of Postoperative Pain in Three Adults Undergoing Tonsillectomy: A Proof-of-Concept Report"],"prefix":"10.1093","volume":"21","author":[{"given":"Cameron R","family":"Smith","sequence":"first","affiliation":[{"name":"Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Helander","sequence":"additional","affiliation":[{"name":"Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil N","family":"Chheda","sequence":"additional","affiliation":[{"name":"Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,3,31]]},"reference":[{"issue":"S100","key":"2020102904120983100_pnaa062-B1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1002\/lary.5541121404","article-title":"Indications for tonsillectomy and adenoidectomy","volume":"112","author":"Darrow","year":"2009","journal-title":"Laryngoscope"},{"issue":"10","key":"2020102904120983100_pnaa062-B2","doi-asserted-by":"crossref","first-page":"PI25","DOI":"10.12659\/MSM.881964","article-title":"Oxycodone and dexamethasone for pain management after tonsillectomy: A placebo-controlled EMG assessed clinical trial","volume":"17","author":"Vaiman","year":"2011","journal-title":"Med Sci Monit"},{"issue":"3","key":"2020102904120983100_pnaa062-B3","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s00405-012-2160-y","article-title":"Comparison of three techniques in adult tonsillectomy","volume":"270","author":"Ozkiris","year":"2013","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"2020102904120983100_pnaa062-B4","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1177\/0194599810389949","article-title":"Clinical practice guideline: Tonsillectomy in children","volume":"144(1_suppl","author":"Baugh","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3","key":"2020102904120983100_pnaa062-B5","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.wjorl.2017.01.001","article-title":"Surgical management of the tonsillectomy and adenoidectomy patient","volume":"3","author":"Wetmore","year":"2017","journal-title":"World J Otorhinolaryngol Head Neck Surg"},{"issue":"3","key":"2020102904120983100_pnaa062-B6","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/pan.12327","article-title":"Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: Barriers and possible solutions","volume":"24","author":"Dorkham","year":"2014","journal-title":"Paediatr Anaesth"},{"issue":"8","key":"2020102904120983100_pnaa062-B7","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1111\/pan.12170","article-title":"Postoperative pain, nausea and vomiting following adeno-tonsillectomy\u2014a long-term follow-up","volume":"23","author":"Stanko","year":"2013","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"2020102904120983100_pnaa062-B8","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/pan.12383","article-title":"Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children","volume":"24","author":"Vons","year":"2014","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"2020102904120983100_pnaa062-B9","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1213\/ANE.0000000000002458","article-title":"Chronic opioid use after surgery: Implications for perioperative management in the face of the opioid epidemic","volume":"125","author":"Hah","year":"2017","journal-title":"Anesth Analg"},{"issue":"1","key":"2020102904120983100_pnaa062-B10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/AAP.0b013e318237516e","article-title":"Impact of perioperative pain intensity, pain qualities, and opioid use on chronic pain after surgery: A prospective cohort study","volume":"37","author":"VanDenKerkhof","year":"2012","journal-title":"Reg Anesth Pain Med"},{"issue":"5","key":"2020102904120983100_pnaa062-B11","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1001\/archinternmed.2011.1827","article-title":"Long-term analgesic use after low-risk surgery: A retrospective cohort study","volume":"172","author":"Alam","year":"2012","journal-title":"Arch Intern Med"},{"issue":"5","key":"2020102904120983100_pnaa062-B12","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1213\/ANE.0000000000002497","article-title":"A review of opioid-sparing modalities in perioperative pain management: Methods to decrease opioid use postoperatively","volume":"125","author":"Kumar","year":"2017","journal-title":"Anesth Analg"},{"issue":"5","key":"2020102904120983100_pnaa062-B13","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.ijporl.2012.01.031","article-title":"Comparison of pre-emptive tonsillar lodge infiltration with ropivacaine versus intravenous tramadol in pediatric tonsillectomies: A randomized placebo-controlled study","volume":"76","author":"Cocelli","year":"2012","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"10","key":"2020102904120983100_pnaa062-B14","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1001\/archotol.127.10.1265","article-title":"Ropivacaine with or without clonidine improves pediatric tonsillectomy pain","volume":"127","author":"Giannoni","year":"2001","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"3","key":"2020102904120983100_pnaa062-B15","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.ijporl.2007.11.011","article-title":"Does topical ropivacaine reduce the post-tonsillectomy morbidity in pediatric patients?","volume":"72","author":"Oghan","year":"2008","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"2020102904120983100_pnaa062-B16","first-page":"CD001874","article-title":"Perioperative local anaesthesia for reducing pain following tonsillectomy","author":"Hollis","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"2020102904120983100_pnaa062-B17","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1097\/ALN.0000000000000171","article-title":"Bilateral suprazygomatic maxillary nerve block for cleft palate repair in children: A prospective, randomized, double-blind study versus placebo","volume":"120","author":"Chiono","year":"2014","journal-title":"Anesthesiology"},{"issue":"3","key":"2020102904120983100_pnaa062-B18","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/0304-3959(91)90220-R","article-title":"The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia","volume":"47","author":"Jebeles","year":"1991","journal-title":"Pain"},{"issue":"4","key":"2020102904120983100_pnaa062-B19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/j.1460-9592.2010.03262.x","article-title":"A new approach for peri-operative analgesia of cleft palate repair in infants: The bilateral suprazygomatic maxillary nerve block","volume":"20","author":"Mesnil","year":"2010","journal-title":"Paediatr Anaesth"},{"issue":"9","key":"2020102904120983100_pnaa062-B20","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1111\/j.1460-9592.2012.03861.x","article-title":"Ultrasound guidance characteristics and efficiency of suprazygomatic maxillary nerve blocks in infants: A descriptive prospective study","volume":"22","author":"Sola","year":"2012","journal-title":"Paediatr Anaesth"},{"key":"2020102904120983100_pnaa062-B21","volume-title":"Anatomy, Head and Neck, Palatine Tonsil (Faucial Tonsils)","author":"Meegalla","year":"2019"},{"key":"2020102904120983100_pnaa062-B22","volume-title":"Pterygopalatine Ganglion Block: For Effective Treatment of Migraine, Cluster Headache, Postdural Puncture Headache & Postoperative Pain","author":"Boezaart","year":"2018"},{"issue":"6","key":"2020102904120983100_pnaa062-B23","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1053\/rapm.2001.26218","article-title":"Anatomic considerations in relation to the maxillary nerve block","volume":"26","author":"Singh","year":"2001","journal-title":"Regional Anesth Pain Med"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/21\/10\/2441\/34050908\/pnaa062.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/21\/10\/2441\/34050908\/pnaa062.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,29]],"date-time":"2020-10-29T08:16:44Z","timestamp":1603959404000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/21\/10\/2441\/5814194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,31]]},"references-count":23,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,3,31]]},"published-print":{"date-parts":[[2020,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnaa062","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,10]]},"published":{"date-parts":[[2020,3,31]]}}}