Post Op Medications: Snoring and OSA Surgery
Snoring is not funny to those whose lives are disrupted by it. But with the expanding medical understanding, there is some relief for the sufferers. The most advanced stage of snoring is obstructive sleep apnea, which causes cardiac, pulmonary and behavioral problems.
Apnea has been described as snoring and choking, a frightening struggle to breathe while asleep. Apnea interrupts loud snoring with episodes of silence during which time, the snorer struggles with unsuccessful respiratory effort.
Heavy snorers should have a thorough examination of the mouth, nose, throat and larynx by an ENT surgeon. Studies in a sleep laboratory or Home (polysomnogram) are essential in adults who have symptoms of sleep apnea.
Surgical treatment is usually reserved as the third option. First being trying to loose weight, avoiding alcohol, life style changes, treating medical causes of snoring and sleep apnea. Next is CPAP, wearing CPAP every night is not someone look forward to. Then the last option is surgery. Rapid advances in this field of surgery have led to excellent results.
Most common is the Laser assisted uvulopalatoplasty, which is basically the removal of the excess tissue behind the nose and throat. The use of the carbon dioxide laser enables an almost bloodless operation under local anesthesia, as an outpatient procedure. Laser tonsillectomy, tongue base reduction by RF Coblator, nasal surgery, mandibular and maxillofacial surgery all being tried with excellent results in selected patients.
Nasal surgery is not at all painful but uncomfortable. The main difficulty is blockage of the nasal airway for the first week after surgery and the dry mouth that results from this. Most discomfort is readily handled by simple pain medications such as Paracetamol (Panadol).
Surgery of the palate and tonsils is painful dependant on the procedure and on the patient’s individual pain thresholds or ability to withstand discomfort. The pain and discomfort may last up to a week but rarely longer. The operation itself is usually pain free following the establishment of local or general anesthetic.
There may be some discomfort that evening. The pain experience may be more significant three to four days after the procedure itself. The painful period usually ends by seven to ten days after the procedure
Coblator surgery of the throat is less painful, but discomfort able for up to two or three days after the procedure, but the patient can usually return to work the following day.
Pain control with medications like narcotic analgesics will be required. Discomfort can be experienced on swallowing worse in the morning.
But at the end: “No gain without Pain” or live a life on CPAP for ever.
Post op Instructions after Laser Surgery of Throat:
The main difficulty experienced by patients after this laser surgery is pain in the roof of the mouth. This discomfort is due to the healing surfaces which are raw and take between a week to ten days to complete the initial healing. There is a gradual healing which takes a much longer time and generally, judgment of snoring improvement should not be made for a two-month period. One week’s absence from work can be anticipated. This procedure is carried out as a one stage operation and only occasionally may require touch-up revision surgery.
The following instructions are for general care following this surgery:
Drink plenty of fluids and frequent chewing of gum helps settle the fluid in the tissues
In the first week, soft foods are to be preferred. No roughage or fibrous, stringy foods which could rub the healing tissue. Soups and soft foods are most easily tolerated.
The pain experienced can be worst between days 3 to 6. The discomfort experienced will vary from patient to patient. The following instruction treatments may be used in part or in whole, dependant on the discomfort need. In general, it is better to use the medication on a regular basis before the pain sets in, rather than waiting for discomfort to occur.
Injection Dexamethasone 8mg IV given during the day of operation. This is to reduce the swelling of the throat tissues.
Should you get any stomach irritation or have a past history of gastric ulcer, Rabeperazole with domperidone (Rabimac DSR®, Rabium DSR®) are given early morning for one week.
Enractin® (trypsin/bromlein) helps reducing the edema. It is taken before food. Diclofenac (Hifenac P®) is also helpful as it contain Paracetamol too. Piroxicam (Dolonex®) in injectable form or dispersible tablets are also effective for pain control.
Dolonat ®: (Paracetamol and Tramadol) Two tablets, 3 to 4 times daily, half an hour before meals, is useful for pain relief, particularly days 3 to 6. Do not take more than 8 tablets per day. (These can cause constipation).
Oral Antibiotics like Cefuroxime (Altacef®) two times a day before meals for five to seven days after surgery.
Mouth Gargles: Betadine as a mouth gargle should be used three times daily. Warm saline gargles after taking meals are advised.