A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy

Objectives:To examine the volume,topics,and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research.Data Sources:PubMed(National Library of Medicine and National Institutes of Health),Scopus(Elsevier),CINAHL(EBSCO),and Cochrane Library(Wiley).Methods:A systematic search of four databases was conducted.Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included.Data collected included demographics,pain-related outcomes,sedation scores,nausea/vomiting,postoperative bleeding,types of drug comparisons,modes of administration,timing of administration,and identities of the investigated drugs.Results:One hundred and eighty-nine studies were included for analysis.Most studies included validated pain scales,with the majority using visual-assisted scales(49.21%).Fewer studies examined pain beyond 24 h postoperation(24.87%),and few studies included a validated sedation scale(12.17%).Studies have compared several different dimensions of pharmacologic treatment,including different drugs,timing of administration,modes of administration,and dosages.Only 23(12.17%)studies examined medications administered postoperatively,and only 29(15.34%)studies examined oral medications.Acetaminophen only had four self-comparisons.Conclusion:Our work provides the first scoping review of pain and pediatric tonsillectomy.With drug safety profiles considered,the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy.Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain.The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta-analyses.Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively.

Survival differences of low-grade versus high-grade head and neck pleomorphic dermal sarcomas and a review of a scalp case

Objective:To examine survival by tumor grade of pleomorphic dermal sarcomas(PDS)of the head and neck(H&N)and review a scalp PDS case.Methods:Patients in the Surveillance,Epidemiology,and End Results(SEER)database were included from 1980 to 2016 based on a diagnosis of H&N PDS.Survival estimates were performed using Kaplan–Meier analysis.Additionally,a case of a grade III H&N PDS is presented.Results:Two hundred-seventy cases of PDS were identified.The mean age at diagnosis was 75.1 years(SD:13.5).Two hundred-thirty-four(86.7%)patients were male.Eighty-seven percent of patients received surgery as a part of their care.The 5-year overall survival rates for grades I,II,III,and IV PDSs were 69%,60%,50%,and 42%,respectively(P=0.03).Conclusions:H&N PDS occurs most commonly in older-age males.Surgical management is frequently a part of H&N PDS care.Survival rates significantly decline based on tumor grade.