Gabapentin - Not for Tonsillectomy Pain
While our patients continue to benefit from the use of the Tonsil Fire Extinguisher with lidocaine for their post tonsillectomy pain, the world continues to search for ways to improve the experience of patients following tonsillectomy.
An interesting pair of articles appeared in the December issue of the Otolaryngology – Head and Heck Surgery journal. Both of these by Dr. James Sanders in New Zealand evaluate the effectiveness of gabapentin given before surgery in the postoperative experience of tonsillectomy patients. In one, a review of the literature on the subject, it appeared that there could be a benefit to this treatment. In the more recent , more rigorous, double blinded, placebo controlled, prospective study, the Gabapentin group actually fared worse. Patients given Gabapentin before surgery reported higher pain scores between day 5 and 10 following surgery. The use of pain medication in the group given Gabapentin was higher than in those that did not get this drug.
It appears that Gabapentin is not worthwhile for tonsillectomy.
Get the Tonsil Fire Extinguisher into your Hospital
Thanks to our relationship with Edge Pharmacy, the Tonsil Fire Extinguisher (TFE) is available to be stocked in your OR from Edge Pharmacy in 35 states. Edge is a 503b outsourcing facility, which means they can sell the devices, filled, in quantity, to be available when needed. We can help make this happen, by providing a letter requesting the TFE with lidocaine to your hospital’s pharmacy committee for you to edit and send. The staff at Edge will be happy to interface with your hospital’s pharmacy to complete the process. Click on Pharmacy to contact EDGE.
A Great Compliment from a Fellow Physician
Dr LD Chiu MD, who practices otolaryngology in Hawaii, heard about our Tonsil Fire Extinguisher in a recent mailing.
She was very kind to send the following message:
“I always like to see successful launches of products invented by doctors. Over the years of AAO-HNS meetings, I’ve met inventors and have always supported them when possible. Last year I spoke to the ENT who invented the Bonaire nasal lotion; I’ve met the couple who made the Tao aspirator for FNA; Dr. French and the Lifestat for cricothyrotomy (I still carry the original with me); the ER MD who invented the Easy IO for interosseous IV placement; the Canadian inventor of the Dizzy Fix for performing a home Epley; and even Dr. Hotchkiss who invented the Hotchkiss otoscope (I have 2 of those and many ENTs don’t even know what it is!). The stories of how people bring ideas to market are amazing.”
We were so pleased to be numbered among these inventors that we sent her a sample with a legacy box. We love the way she displayed it! It not only speaks to the playfulness of the product, but the smiling ENT man means it’s really useful!
Cochrane Review: Topical Lidocaine Effective for Post Tonsillectomy Pain
The Cochrane group, which analyzes the literature covering various medical treatments, published a paper in 2013 on the effects of oral rinses, mouthwashes and sprays in improving recovery following tonsillectomy.
They included randomized controlled trials in which oral rinses, mouthwashes and sprays, used pre- and post-operatively, had been compared with placebo in adults or children undergoing tonsillectomy.
Of the seven trials they studied that met their criteria for inclusion, studying topical Hydrogen Peroxide, Benzydamine HCl, and Lidocaine spray, they found that “Lidocaine spray appeared to be more effective than saline spray at reducing the severity of pain until the third postoperative day.” Neither of the other interventions demonstrated a significant effect.
Our patients know how effective this treatment can be. We encourage other scientists to study the question in a systematic way. We can provide study designs on request.
Physicians Continue to Look for the Ideal Post Tonsillectomy Pain Regimen
A Study published in Otolaryngology Head and Neck Surgery Nov 2016 looks at prescribing patterns and outcomes in the treatment of post-tonsillectomy pain. The study, by the Intermountain Health group in Utah, compared the effectiveness of acetaminophen with either ibuprofen, narcotic, or both.
Ibuprofen was superior to narcotic or ibuprofen with narcotic on days 2 and 3. There was no significant difference at day 7 or 14.
In this study, only 7% received a local anesthetic, and data from these patients was not analyzed.
We believe that we should be able to eliminate the use of narcotics post tonsillectomy, and this study supports this. Still, many parents and adult patients feel the need for something for breakthrough pain. We think the Tonsil Fire Extinguisher with lidocaine fulfills this need.
Tonsil Fire Extinguisher Samples Are on the Way
We have completed the mailing of Tonsil Fire Extinguisher samples to our US colleagues. Each physician will receive 6 devices for use on their older children and adult tonsillectomy patients. We are excited to hear about what their patients think about the effect on their post tonsillectomy pain. In this special mailing, we included some of the special flavoring we use to mask the taste of the lidocaine. This sampling is available to any US physician who has not yet tried the Tonsil Fire Extinguisher. Just visit the Sample page and we’ll send you some!
Doctors Surprise Us at AAO-HNS
Physician and nurse attendees discussed the use of the Tonsil Fire Extinguisher, and how it might fit best into their practice in improving tonsillectomy recovery.
In a big change from last year, perhaps because we are now able to offer flavoring, many physicians now feel more comfortable about filling the devices in the office, and being able to offer the device less expensively to the patient. If you haven’t tried it yet, go to the Sample page and we’ll send you 6 devices and some flavoring.
There is also plenty of enthusiasm for getting the hospital/surgicenter/medical group pharmacy to carry the device and do the compounding. That gets the treatment into the OR and RR, which is great, and rolls the cost into the insurance-covered day surgery charges!
Tonsil Fire Extinguisher Goes to San Diego
Brillient Doctors is enthusiastically looking forward to the upcoming meeting of the AAO-HNS in San Diego. We will be at booth #1352 and invite all participants to come and learn about our new concept in post tonsillectomy pain management. You could be doing more to help your patients recover from this very difficult procedure.
We firmly believe that physicians in practice can decide what works for their patients!
We are offering a set of six Tonsil Fire Extinguishers® free to all US physicians. We will mail the devices to each doctor to fill with Lidocaine in his/her office and solicit their feedback on how their patients liked using it. For those physicians who prefer to prescribe, we will offer a six $25 rebate coupons to defray their patients’ expenses in obtaining our Tonsil Fire Extinguisher, and will solicit the patient’s opinions as they request their refunds. We will post the data as we receive it!
In addition, the first 200 visitors to the booth will receive a free bottle of candy flavoring to be used as they see fit. We like using it to flavor the lidocaine in our treatment room in addition to using it with the tonsil fire extinguisher.