Madani M
Center for Corrective Jaw Surgery, Bala Cynwyd, PA, USA.
J Oral Maxillofac Surg. 2000 Oct;58(10 Suppl 2):27-31. doi: 10.1053/joms.2000.17881.
Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) is a recently developed technique for treating snoring and mild sleep apnea. This treatment is associated with severe postoperative pain. This study evaluated the effectiveness and safety of transnasal administration of butorphanol tartrate (Stadol NS; Bristol-Myers Squibb, New York, NY) as a primary means of controlling pain after this surgical procedure.
Twenty patients (14 men and 6 women; mean age, 43 years) were enrolled and treated with LA-UPPP and radiofrequency turbinate procedures (coblation) for severe snoring and chronic nasal congestion in an open label study. The same surgeon performed all procedures. Patients were advised to take 2 tablets of ibuprofen (200 mg each) and use a single 1 mg spray of Stadol NS in 1 nostril for the initial dose. If adequate pain relief was not achieved in 1 to 1.5 hours, an additional 1 mg dose of Stadol NS was recommended. Thereafter, they could repeat the ibuprofen and Stadol NS every 3 to 4 hours, as needed. Comprehensive preoperative and postoperative evaluations were made using a visual analog scale of 0 to 10, with 0 equal to no pain and 10 being the most severe. Patients were followed-up for 14 days.
All 20 patients had LA-UPPP and nasal turbinate radiofrequency coblation, and all 20 were eligible for both efficacy and safety analysis. Pain was reduced from a mean of 6.6 to a mean of 3.3 (50%) after an average of 48 minutes after the initial dose.
Stadol NS appears to be an effective treatment for moderate-to-severe pain after LA-UPPP. If patients have difficulty swallowing, which is the case with most throat surgeries performed by oral and maxillofacial surgeons and otolaryngologists, the transnasal route of administration reduces the number of oral medications taken by the patient.
