Introduction
Adenotonsillectomy or tonsillectomy is one of the most common pediatric surgeries in the field of ear, nose, and throat (ENT). In developed countries such as the United States and Germany, these surgeries annually exceed 600000 and approximately 400000, respectively [1]. Palatine tonsils are the largest accumulation site of lymphoid tissue in the Waldeyer’s ring [2]. They play a significant role in the local immune response and antigen recognition, as they contain many lymphocytes, producing immunoglobulins [3]. However, various organisms can affect lymphoid tissue, leading to inflammation, infection, or hypertrophy [4]. Indications for the surgical resection of hypertrophied tonsils comprise upper respiratory tract obstruction, causing nocturnal snoring, sleep apnea; dental changes; mouth breathing; infectious symptoms like bad breath; recurrent tonsillitis; peritonsillar abscess; acute rheumatic fever; and suspicion of malignancy or cryptic tonsils [5].
Pain control techniques in tonsillectomy can be categorized into preoperative, intraoperative, and postoperative approaches. The goal is to manage pain effectively and minimize discomfort for the patient during and after the procedure. This study reviews techniques and compares their effectiveness in tonsillectomy surgery.

Preoperative pain control
Preoperative pain control consists of patient education, medications, and regional anesthesia. The education comprises informing the patient about the procedure, expected pain levels, and the importance of adhering to postoperative pain management instructions. These measures can help manage the patients’ expectations and anxiety. Medications consist of preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen that reduce inflammation and preemptively manage pain. Finally, regional anesthesia involves local anesthetic injections around the tonsils or the base of the tongue to provide immediate pain relief post-surgery.

Intraoperative pain control
Intraoperative pain control involves general and local anesthesia. Most tonsillectomy surgeries are performed under general anesthesia to ensure the patient is unconscious during the procedure and does not experience pain. Local anesthetics can be administered during the process to reduce postoperative pain.

Postoperative pain control
Postoperative pain control involves using medications, patient-controlled analgesia, and regional anesthesia. Medications comprised two categories: Opioids and non-opioids. Opioids like codeine or hydrocodone have been used to manage postoperative pain. However, they have side effects, including the risk of addiction, and should be used cautiously. Non-opioid analgesics like NSAIDs and acetaminophen can be used in combination to manage pain while reducing the need for opioids.
Some patients are provided with a patient-controlled analgesia (PCA) pump, which allows them to self-administer a preset dose of pain medication, usually opioids.
Finally, continuing the use of local anesthetics can extend postoperative pain relief.

Comparing pain control techniques in tonsillectomy
Preoperative pain control techniques are primarily aimed at reducing the baseline pain level before the procedure, but they may not provide complete pain relief during or immediately after surgery. Intraoperative pain control is mainly accomplished through general anesthesia, ensuring the patient is unconscious during the surgery, but it does not address postoperative pain. Postoperative pain control is crucial for managing pain after the procedure. The choice of medication and technique can significantly impact a patient’s recovery and comfort.
Opioids are effective at managing severe postoperative pain but have potential side effects, such as nausea, constipation, and the risk of addiction. Non-opioid analgesics, such as NSAIDs and acetaminophen, can be effective in managing postoperative pain and have fewer side effects compared to opioids. PCA empowers the patient to control their pain medication dosing, which can lead to better pain management and potentially reduce the total amount of medication required. Regional anesthesia, both preoperatively and postoperatively, can provide localized pain relief but may not be sufficient for severe postoperative pain.
Ultimately, the choice of pain control techniques in tonsillectomy surgery should be individualized based on the patient’s specific needs, medical history, and the surgeon’s recommendations. A balanced approach that minimizes opioid use while ensuring adequate pain relief is often preferred to optimize recovery and reduce potential opioid-related complications.
Furthermore, studies have shown that tonsillectomy surgery can be associated with complications such as pain, postoperative bleeding, airway obstruction, and electrolyte disturbances. Since postoperative pain is a significant care issue in terms of patient health, multiple factors contribute to inadequate pain control [6, 7]. Throat or referred ear pain can cause patients to avoid swallowing and delays in oral intake, resulting in complications such as pharyngeal muscle spasms, increased pain during swallowing, increased risk of infection, and prolonged recovery period [8]. Therefore, this review article aims to evaluate pain management methods in tonsillectomy surgery and provide preoperative, intraoperative, and postoperative pain control techniques.

Methods 
A comprehensive search of electronic databases, including PubMed, Embase, and Cochrane Library, was conducted for data gathering. The search strategy employed a combination of keywords related to the study topic, including tonsillectomy, preoperative, intraoperative, postoperative, opioid, pharmacology, technology, recovery, hospitalization, discharge, enhanced recovery after surgery (ERAS), comfort, long-term, pediatrics, multimodal, education, expectation, and psychology. The selected studies were thoroughly studied and finalized. The inclusion criteria encompassed studies published between January 2000 and September 2022, written in English, and involved pediatric and adult patients undergoing tonsillectomy. Randomized controlled trials, prospective and retrospective cohort studies, as well as systematic reviews and meta-analyses, were included. The identified studies were screened based on their titles and abstracts, followed by a full-text review to assess their relevance to the topic.

Results and Discussion
Finally, many articles were extracted from the databases and used to write the article.
Palatine tonsils are the largest accumulation site of lymphoid tissue in Waldeyer’s ring, consisting of tonsils and adenoids. Due to their exposure to various organisms and flora, they can become infected, inflamed, or hypertrophied, so tonsillectomy with or without adenoidectomy is indicated in these cases [2].
Tonsillectomy, the surgical removal of tonsils, is a common procedure in pediatric otolaryngology. Different techniques are used for tonsil removal, which can be categorized based on obstructive or infectious indications. Obstructive indications include conditions such as nocturnal snoring, chronic mouth breathing, obstructive sleep apnea, and hypertrophy of the adenotonsillar tissue with associated complications. Infectious indications encompass acute tonsillitis, peritonsillar abscess, and recurrent tonsillitis unresponsive to medical treatment [9].
Adenoidectomy, the removal of adenoids, is often performed concurrently with tonsillectomy and is indicated for obstructive and infectious conditions such as adenoid hypertrophy with associated chronic sinusitis or suspected malignancy. These surgeries are not without risks, including various complications such as postoperative pain, bleeding, airway obstruction, lung edema, valvular insufficiency, and nasopharyngeal obstruction [10, 11].

Postoperative pain 
Millions of individuals undergo surgical procedures every day worldwide, and postoperative pain is a common experience. Inadequate pain control can lead to adverse effects such as atelectasis, thromboembolism, myocardial ischemia, cardiac arrhythmias, electrolyte disturbances, urinary retention, and even ileus. Postoperative pain in tonsillectomy surgery is characterized by pain at the surgical site (throat) and referred pain to the ears. The discomfort experienced by children due to throat pain often results in a reluctance to initiate oral intake, leading to complications such as dehydration, increased body temperature, and prolonged recovery and hospitalization. Additionally, respiratory compromise resulting from severe postoperative pain can increase the risk of infection. Therefore, effective pain management in the postoperative period is crucial, particularly during the transition from anesthesia to patient awakening, as timely pain control is optimal during this period, while delayed administration of analgesics after patient awakening and pain perception may have limited efficacy [12].

Tonsillectomy surgery
Tonsillectomy, like any surgical procedure, carries the risk of complications. Although rare, serious complications can occur, including postoperative bleeding, airway obstruction, lung edema, valvular insufficiency, and nasopharyngeal obstruction. Postoperative bleeding is a significant concern, as it can lead to increased morbidity and the need for additional interventions such as blood transfusion or reoperation. Close monitoring of patients in the immediate postoperative period is crucial to detect and manage complications promptly. Using meticulous surgical techniques, appropriate hemostasis, and adherence to postoperative care guidelines can help reduce the incidence of complications and improve patient outcomes [13].

Recovery and hospitalization
Pain management plays a crucial role in facilitating the recovery process and reducing the length of hospitalization. Children undergoing tonsillectomy surgery often experience discomfort and difficulty swallowing, which can lead to a decreased desire to eat and drink. This reluctance to initiate oral intake can result in dehydration and increased body temperature. Therefore, pain control is essential to alleviate discomfort and encourage adequate fluid and food intake, ensuring proper hydration and nutrition [14]. Optimizing pain management strategies can help shorten the recovery period, minimize the need for prolonged hospitalization, and improve overall patient satisfaction.

Patient comfort and satisfaction 
The experience of pain can significantly impact patient comfort and satisfaction following tonsillectomy. Inadequate pain control can result in prolonged discomfort and the patient’s overall well-being and quality of life during recovery. It is essential for healthcare providers to prioritize pain management and tailor interventions to meet individual patient’s needs. By implementing effective pain management strategies, such as multimodal and patient-controlled analgesia, healthcare professionals can optimize pain control, enhance patient comfort, and improve overall satisfaction with the surgical experience [15].

Long-term outcomes
While immediate pain management is crucial, long-term outcomes following tonsillectomy surgery also warrant consideration. Studies have shown that inadequate pain control during the early postoperative period can lead to the development of chronic pain and persistent discomfort in some patients. Long-term follow-up and assessment of pain outcomes can provide valuable insights into the effectiveness of pain management strategies and guide future interventions to mitigate the risk of chronic pain development. Additionally, evaluating patient-reported outcomes, such as quality of life measures and functional improvement, can contribute to a comprehensive understanding of the long-term impact of tonsillectomy surgery [16, 17].
By addressing complications, focusing on recovery and hospitalization, ensuring patient’s comfort and satisfaction, and considering long-term outcomes, healthcare professionals can enhance the overall management of pain in tonsillectomy surgery [18]. Continued research and advancements in pain management techniques are essential to improve patient outcomes further and optimize the surgical experience for individuals undergoing tonsillectomy procedures.
Effective pain relief strategies are paramount in various medical contexts, and recent studies have shed light on the importance of comprehensive pain management in tonsillectomy procedures. These insights emphasize the need to address pain concerns proactively and comprehensively throughout the surgical journey.
One study focusing on COVID-19 vaccine side effects reveals that understanding and managing side effects can draw parallels between the challenges of pain management in tonsillectomy. Just as post-vaccine discomfort can affect patients, inadequate pain control in tonsillectomy can lead to prolonged recovery and complications [19]. Patients’ anxieties about potential side effects can be alleviated through education and expectation management, which reflects the importance of patient education in the context of tonsillectomy.
Another study on the successful treatment of skin lesions in epidermolysis bullosa (EB) patients highlights the significance of effective pain relief before and after tonsillectomy. This research demonstrates that multimodal pain management techniques can significantly enhance patients’ quality of life and overall recovery [20]. Similar approaches in the tonsillectomy setting can help optimize patient comfort.
The case of desmoplastic fibroma treatment further underscores the critical role of pain management in various medical procedures. As demonstrated in this case, swift and effective pain relief can improve patient outcomes. By adopting regional anesthesia techniques and a multimodal pain control regimen [21], similar benefits can be achieved in tonsillectomy patients.
Comparative studies of COVID-19 vaccines and their side effects provide valuable insights into the multifaceted nature of pain management. Just as vaccine recipients experience varying side effects, [22] post-tonsillectomy pain intensity and prevalence can differ significantly. Implementing multimodal analgesia with a combination of non-opioid and opioid medications aligns with the principles of synergistic pain relief found in vaccine studies.
The interplay between COVID-19 and multiple sclerosis, particularly the ocular symptoms, highlights how different medical conditions can influence pain perception. Considering patients’ unique health backgrounds is essential in tailoring pain management strategies during tonsillectomy procedures [23].
The rare case of Mycobacterium marinum skin infection supports how significant proper diagnosis and treatment are [24]. Similarly, addressing pain effectively in tonsillectomy requires a tailored approach to individual patient needs.
Gender-based analysis of COVID-19 vaccine side effects reveals potential variations in pain perception and management requirements among different patient demographics [25, 26]. Acknowledging these differences is crucial in ensuring that pain relief strategies should be tailored to each patient’s needs during tonsillectomy.
In conclusion, the lessons collected from various medical studies underscore the significance of holistic pain management in tonsillectomy procedures. By drawing parallels between studies on vaccine side effects [27], skin conditions, and diverse patient demographics, healthcare providers can implement tailored pain relief strategies that enhance patient comfort, promote swift recovery, and optimize postoperative outcomes.

Pediatric considerations
Tonsillectomy is a commonly performed procedure in pediatric patients. Managing postoperative pain in children presents unique challenges due to their limited ability to communicate discomfort effectively. Therefore, age-appropriate pain assessment tools and strategies are crucial for accurately evaluating pain intensity and tailoring pain management interventions. Additionally, healthcare providers must consider the appropriate dosing and administration of analgesics in children to ensure optimal pain relief while minimizing potential side effects. Non-pharmacological interventions, such as distraction techniques or the use of age-appropriate toys, can also be incorporated to enhance pain management in this population [28, 29].

Multimodal analgesia
Given the complexity and variability of postoperative pain experienced after tonsillectomy, a multimodal analgesia approach has gained recognition. This approach involves combining different medications with complementary mechanisms of action to provide more effective pain relief while minimizing opioid consumption and associated side effects. Non-opioid analgesics, such as acetaminophen and NSAIDs, are commonly utilized in combination with opioids to achieve synergistic pain control. Furthermore, adjunctive therapies like regional anesthesia techniques (e.g. local anesthesia or peripheral nerve blocks) and techniques like cold therapy or transcutaneous electrical nerve stimulation can also be considered part of a multimodal approach [30, 31].

Patient education and expectations
Effective pain management in tonsillectomy surgery requires proactive patient education and setting appropriate expectations. Informing patients and their caregivers about the potential severity and duration of postoperative pain, along with the available pain management strategies, can help alleviate anxiety and enhance compliance with prescribed treatments. Educating patients about early pain control, maintaining hydration, and gradually reintroducing oral intake can improve postoperative outcomes. In addition, addressing concerns and providing ongoing support and reassurance throughout the recovery process can improve patient satisfaction and overall experience [10, 32].

Role of regional anesthesia
Regional anesthesia techniques have gained attention in tonsillectomy for their potential to provide targeted pain relief and reduce the need for systemic opioids. Peripheral nerve blocks, such as the glossopharyngeal or superior laryngeal nerve block, can achieve regional anesthesia in the tonsillar region. These techniques offer the advantage of reducing postoperative pain and improving patient comfort, allowing for earlier oral intake and potentially shorter hospital stays. Further research and evaluation of regional anesthesia’s safety, efficacy, and optimal timing in tonsillectomy patients can contribute to refining pain management protocols [33].

Psychological factors
Pain is a multifaceted experience influenced not only by physiological factors but also by psychological and emotional aspects. Factors such as anxiety, fear, and previous pain experiences can influence the perception and tolerance of pain. Addressing patients’ psychological well-being and providing appropriate support can positively impact pain management outcomes. Techniques such as cognitive-behavioral therapy, relaxation techniques, and distraction methods can be incorporated to help patients cope with pain and reduce anxiety. A holistic approach that considers pain’s physical and psychological aspects can improve pain control and overall patient satisfaction.

Patient-reported outcomes
Patient-reported outcomes (PROs) are vital in assessing pain management effectiveness and capturing the patient’s perspective. PRO measures, such as pain intensity scales, functional assessments, and quality of life questionnaires, provide valuable insights into the impact of pain on patients’ daily activities, sleep patterns, and overall well-being. Incorporating PROs into clinical practice allows for individualized pain management approaches and the ability to monitor treatment outcomes over time. By regularly collecting and analyzing PRO data, healthcare providers can identify areas for improvement and tailor interventions to meet patients’ specific needs [34].

Optimizing discharge planning 
Pain management should extend beyond the hospital stay, and optimizing discharge planning is essential for continued pain control and patient well-being. Providing clear instructions on pain medication dosing and administration, potential side effects, and when to seek medical assistance can empower patients and caregivers to manage pain at home effectively. Ensuring access to appropriate analgesics and addressing any concerns or questions during follow-up appointments contributes to a smooth recovery process. Collaboration among healthcare providers, including surgeons, anesthesiologists, and primary care providers, is crucial for comprehensive and coordinated care during the postoperative period [35].

Role of ERAS protocols
ERAS protocols have emerged as a comprehensive approach to optimize patient care and outcomes in various surgical procedures, including tonsillectomy. These multimodal perioperative care pathways incorporate evidence-based interventions to minimize surgical stress, reduce complications, and enhance recovery. Within the context of pain management, ERAS protocols may include preoperative education and counseling, standardized analgesic protocols, and early mobilization. Implementing ERAS protocols in tonsillectomy surgery can improve pain control, faster recovery, shorter hospital stays, and enhanced patient satisfaction [36].

Role of technology
Technology can revolutionize pain management in tonsillectomy surgery. For example, virtual reality (VR) technology has shown promising results in reducing pain and anxiety by providing immersive and distraction-based experiences. VR-based interventions can be used preoperatively to alleviate preoperative anxiety and during the postoperative period to distract patients from pain and discomfort. Additionally, smartphone applications and wearable devices can enable real-time monitoring of pain levels and facilitate remote communication between patients and healthcare providers for timely pain management interventions. Embracing technological advancements in pain management can enhance patient experiences and outcomes [37, 38].

Special considerations in adult tonsillectomy
While tonsillectomy is commonly performed on pediatric patients, adults can undergo the procedure for various indications. However, pain management in adult tonsillectomy may present unique challenges due to differences in pain perception, comorbidities, and medication requirements. Strategies such as individualized pain management plans, consideration of comorbid conditions, and close monitoring of medication interactions are crucial in adult patients. Moreover, exploring alternative analgesic techniques, such as intravenous lidocaine infusions or non-pharmacological approaches, may be beneficial in this population. Further research focusing specifically on pain management in adult tonsillectomy patients is warranted [29, 39].

Importance of postoperative follow-up
 Adequate postoperative follow-up is vital for monitoring pain resolution, managing complications, and ensuring patient well-being after tonsillectomy surgery. Regular follow-up visits allow healthcare providers to assess pain levels, evaluate wound healing, and address any concerns or complications that may arise. In addition to pain assessment, follow-up visits provide an opportunity to provide ongoing education on pain management techniques, reinforce medication adherence, and assess the need for further interventions or adjustments in the pain management plan. Emphasizing the importance of postoperative follow-up and ensuring continuity of care can contribute to optimal pain control and patient satisfaction [29, 32].

Conclusion
Accurate data on the prevalence of postoperative pain after tonsillectomy is currently unavailable in Iran. However, studies conducted in other countries, have reported a prevalence of postoperative tonsillectomy pain ranging from 40% to 73%. It is essential to focus on pain control during the period between the completion of surgery and patient awakening. Administering analgesics before pain perception begins while discontinuing anesthesia and the patient awakening is an optimal approach. Delayed administration of analgesics after patient awakening and pain onset may have limited effectiveness. Implementing effective pain management strategies is crucial for minimizing complications, improving patient comfort, and facilitating a faster recovery. Pain management between surgery completion and patient awakening is of utmost importance. By implementing effective pain management strategies, healthcare professionals can minimize complications, enhance patient comfort, and facilitate a faster recovery. Further research is needed to gather specific data on pain management in tonsillectomy patients in Iran and explore additional interventions to optimize postoperative pain control and improve patient outcomes.

Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors thank the Intensive Care Unit staff of Boo-Ali Sina Hospital.


​​​​​​​References

1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report. 2009; (11):1-25. [PMID]
2. Richardson MA. Sore throat, tonsillitis, and adenoiditis. Med Clin North Am. 1999; 83(1):75-83. [DOI:10.1016/S0025-7125(05)70088-2] [PMID]
3. Shaaker M, Mehdizadeh A, Ezzeddini R, Ghasemi B, Jabbari Moghaddam Y, Abdollahi Fakhim S, et al . The study of serum and tissue cholesterol levels in children undergoing tonsillectomy. J Inflam Dis. 2018; 22(4):4-12 [DOI:10.29252/qums.22.4.4]
4. Shatz A. Indications and outcomes of adenoidectomy in infancy. Ann Otol Rhinol Laryngol. 2004; 113(10):835-8. [DOI:10.1177/000348940411301011] [PMID]
5. Torretta S, Rosazza C, Pace ME, Iofrida E, Marchisio P. Impact of adenotonsillectomy on pediatric quality of life: Review of the literature. Ital J Pediatr. 2017; 43(1):107. [DOI:10.1186/s13052-017-0424-2] [PMID]   
6. Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. Pain Manag Nurs. 2008; 9(1 Suppl):S11-21. [DOI:10.1016/j.pmn.2007.11.006] [PMID]
7. Pagé MG, Stinson J, Campbell F, Isaac L, Katz J. Pain-related psychological correlates of pediatric acute post-surgical pain. J Pain Res. 2012; 5:547-58. [DOI:10.2147/JPR.S36614] [PMID]
8. Moghaddam YJ, Kalami L, Radfar R, Ragifar R. [Comparisional results of paractamol and diclofanac suppository on post tonsillectomy pain control in children (Persian)]. Med J Tabriz Univ Med Sci. 2009; 31(1):31-4. [Link]
9. Wiatrak BJ, Woolley AL. Pharyngitis and adenotonsillar disease. Otolaryngol Head Neck Surg. 2005; 3:188-215. [Link]
10. White MC, Nolan JA. An evaluation of pain and postoperative nausea and vomiting following the introduction of guidelines for tonsillectomy. Paediatr Anaesth. 2005; 15(8):683-8. [DOI:10.1111/j.1460-9592.2004.01516.x] [PMID]
11. Wilson JT, Murray A, MacKenzie K. Prospective study of morbidity after tonsillectomy in children. Int J Pediatr Otorhinolaryngol. 2001; 58(2):119-25. [DOI:10.1016/S0165-5876(01)00416-5] [PMID]
12. Tan GX, Tunkel DE. Control of pain after tonsillectomy in children: A review. JAMA Otolaryngol Head Neck Surg. 2017; 143(9):937-42. [DOI:10.1001/jamaoto.2017.0845] [PMID]
13. Dadgarnia MH, Aghaei MA, Atighechi S, Behniafard N, Vahidi MR, Meybodian M, et al. The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection. Int J Pediatr Otorhinolaryngol. 2016; 89:38-41. [DOI:10.1016/j.ijporl.2016.07.022] [PMID]
14. Junaid M, Sood S, Walijee H, Dorgham J, De S. Pain scores and recovery post tonsillectomy: Intracapsular versus extracapsular coblation. J Laryngol Otol. 2019; 133(9):775-781. [DOI:10.1017/S0022215119001610] [PMID]
15. Lee J, Delaney K, Napier M, Card E, Lipscomb B, Werkhaven J, et al. Child pain intensity and parental attitudes toward complementary and alternative medicine predict post-tonsillectomy analgesic use. Children. 2020; 7(11):236. [DOI:10.3390/children7110236] [PMID]
16. Cohen N, Sommer DD. Post-tonsillectomy pain control: Consensus or controversy? Pain Manag. 2016; 6(1):31-7. [DOI:10.2217/pmt.15.58] [PMID]
17. Kan Y, Sumikawa Y, Hida T, Ajiki S, Uhara H. Prognostic factors and long-term efficacy of tonsillectomy in 17 patients with pustulotic arthro-osteitis. Eurasian J Med. 2020; 52(1):103-5. [DOI:10.5152/eurasianjmed.2019.19099] [PMID]   
18. Jotić A, Savić Vujović K, Milovanović J, Vujović A, Radin Z, Milić N, et al. pain management after surgical tonsillectomy: Is there a favorable analgesic? Ear Nose Throat J. 2019; 98(6):356-61. [DOI:10.1177/0145561319846065] [PMID]

19. Abdollahi A, Naseh I, Kalroozi F, Kazemi-Galougahi MH, Nezamzadeh M, Frouzanian M, et al. Is there an association between side effects of astrazeneca, sputnik, covaxin and sinopharm COVID-19 vaccines and Breakthrough Infections? Tabari Biomed Stud Res J. 2022; 4(2):23-30. [DOI:10.18502/tbsrj.v4i2.9662]
20. Abdollahi A, Kadkhodaee R, Kazeminejad A, Davoodi L, Karimi MO, Razavi A, et al. Topical Formulation Based on Arnebia euchroma as a Novel Possible Efficient Treatment on Epidermolysis Bullosa Lesions: A Case Series of Fourteen Patients. South East Eur J Immunol. 2023; 6(1):56-61. [DOI:10.3889/seejim.2023.6035]
21. Razavipour M, Akhlaghi H, Abdollahi A. Overcoming diagnostic challenges in desmoplastic fibroma of the scapula: A rare case report. Oxf Med Case Reports. 2023; 2023(8):omad057.[DOI:10.1093/omcr/omad057] [PMID]
22. Abdollahi A, Naseh I, Kalroozi F, Kazemi-Galougahi MH, Nezamzadeh M, Qorbanzadeh A, et al. Potential adverse effects of COVID-19 vaccines on iranian healthcare workers: Comparison of four available vaccines in Tehran: A retrospective cross-sectional study. Oman Med J. 2023; 38(2):e486. [DOI:10.5001/omj.2023.69] [PMID]
23. Frouzanian M, Jafarpour H, Razavi A. Multiple sclerosis and COVID-19 as two triggers of conjunctivitis: A case report. MOJ Clin Med Case Rep. 2023; 13(1):17-9. [DOI:10.15406/mojcr.2023.13.00428]
24. Davoodi L, Kazeminejad A, Abdollahi A. Rare skin manifestation of Mycobacterium marinum, lesion on shoulder: A case report. MOJ Clin Med Case Rep. 2022; 12(3):44-5. [DOI:10.15406/mojcr.2022.12.00418]
25. Abdollahi A, Naseh I, Galougahi MHK, Kalroozi F, Nezamzadeh M, Khajevand N, et al. Side effects of the sinopharm/BBIBP COVID-19 vaccine among iranian healthcare workers: A gender assessment. Iran Red Crescent Med J. 2022; 24(8):e1974. [DOI:10.32592/ircmj.2022.24.8.1974]
26. Abdollahi A, Naseh I, Kazemi-Galougahi MH, Kalroozi F, Nezamzadeh M, Feyzollahi M, et al. Comparison of four types of vaccines Sinopharm, AstraZeneca, Sputnik V, and Covaxin in terms of morbidity and severity of COVID-19 in vaccinated personnel of several selected medical centers, Tehran, Iran. Int J Med Invest 2022; 11(2):56-65. [Link]
27. Abdollahi A, Naseh I, Kalroozi F, Kazemi-Galougahi MH, Nezamzadeh M, Sabeti Billandi S, et al. Comparison of side effects of COVID-19 vaccines: Sinopharm, AstraZeneca, Sputnik V, and Covaxin in women in terms of menstruation disturbances, hirsutism, and metrorrhagia: A descriptive-analytical cross-sectional study. Int J Fertil Steril. 2022; 16(3):237-43. [DOI:10.22074/ijfs.2022.544706.1236] [PMID] [PMCID]
28. Howard D, Davis KF, Phillips E, Ryan E, Scalford D, Flynn-Roth R, et al. Pain management for pediatric tonsillectomy: An integrative review through the perioperative and home experience. J Spec Pediatr Nurs. 2014; 19(1):5-16. [DOI:10.1111/jspn.12048] [PMID]
29. Richards J, Lang M, Andresen E, O'Leary K, Jauncey-Cooke J, Anderson N, et al. Impact of paediatric tonsillectomy perioperative management on pain, nausea and recovery: A prospective cohort study. J Paediatr Child Health. 2020; 56(1):114-22. [DOI:10.1111/jpc.14505] [PMID]
30. Tolska HK, Hamunen K, Takala A, Kontinen VK. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. Br J Anaesth. 2019; 123(2):e397-411. [DOI:10.1016/j.bja.2019.04.063] [PMID]
31. Ashbach MN, Ostrower ST, Parikh SR. Tonsillectomy techniques and pain: A review of randomized controlled trials and call for standardization. ORL J Otorhinolaryngol Relat Spec. 2007; 69(6):364-70. [DOI:10.1159/000108369] [PMID]
32. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: Tonsillectomy in children (update)-executive summary. Otolaryngol Head Neck Surg. 2019; 160(2):187-205. [DOI:10.1177/0194599818807917] [PMID]
33. Grainger J, Saravanappa N. Local anaesthetic for post-tonsillectomy pain: A systematic review and meta-analysis. Clin Otolaryngol. 2008; 33(5):411-9. [DOI:10.1111/j.1749-4486.2008.01815.x] [PMID]
34. Postier AC, Chambers C, Watson D, Schulz C, Friedrichsdorf SJ. A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials. Pain Rep. 2020; 5(2):e819. [DOI:10.1097/PR9.0000000000000819] [PMID]   
35. Gilani S, Bhattacharyya N. Revisit rates for pediatric tonsillectomy: An analysis of admit and discharge times. Ann Otol Rhinol Laryngol. 2020; 129(2):110-4. [DOI:10.1177/0003489419875758] [PMID]
36. Chorath K, Hobday S, Suresh NV, Go B, Moreira A, Rajasekaran K. Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: Review of literature. World J Otorhinolaryngol Head Neck Surg. 2022; 8(2):96-106. [DOI:10.1002/wjo2.58] [PMID]   
37. Cai FG, Hong W, Ye Y, Liu YS. Comparative systematic review and meta-analysis of the therapeutic effects of coblation tonsillectomy versus electrocautery tonsillectomy. Gland Surg. 2022; 11(1):175-85. [DOI:10.21037/gs-21-832] [PMID]
38. Eijlers R, Dierckx B, Staals LM, Berghmans JM, van der Schroeff MP, Strabbing EM, et al. Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial. Eur J Anaesthesiol. 2019; 36(10):728-37. [DOI:10.1097/EJA.0000000000001059] [PMID]
39. Fayoux P, Wood C. Non-pharmacological treatment of post-tonsillectomy pain. Eur Ann Otorhinolaryngol Head Neck Dis. 2014; 131(4):239-41. [DOI:10.1016/j.anorl.2014.07.002] [PMID]