Effect of pre‐ vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy

Abstract

Background: Since pre‐incisional peritonsillar infiltrations of local anesthetic solutions have been suggested to reduce postoperative pain after tonsillectomy, we compared the efficacy of either pre‐ or postoperative local anesthetic infiltration upon post‐tonsillectomy pain.Methods: After the induction of general anesthesia, 68 consecutive healthy patients, ranging in age from 8 to 65 years, were randomly allocated to either receive peritonsillar infiltration with 0.25% bupivacaine (group 1) or normal saline (group 2) before incision. A third group (group 3) had their peritonsillar region infiltrated with 0.25% bupivacaine after the completion of surgery but before the patients were awakened from anesthesia. All the patients were treated in the same way in the postoperative period: NSAIDs were given intravenously to adults and rectally to children. Acetaminophen was given intravenously or rectally (children aged < 15 yr) if additional analgesic support was requested by the patient. Additional acetaminophen consumption was recorded daily. Pain scores were assessed on every patient with the use of a visual analogue scale (VAS) at rest, 1, 5, 9, 13, 17, 21 and 36 h after surgery, and also on swallowing during the first postoperative day.Results: Global VAS pain scores were lower in the groups treated with bupivacaine infiltration during the first 24 h after surgery (P < 0.05). Supplementary analgesic consumption was lower in group 3 than in group 2 during the 0–9 h interval immediately following surgery (P < 0.05). There were no statistically significant differences for any other parameters between the 3 groups.Conclusion: These results suggest that the timing of peritonsillar infiltration with bupivacaine is not of clinical importance and does not affect the quality of postoperative analgesia in patients undergoing tonsillectomy.

Effects of Levobupivacaine versus Bupivacaine Infiltration on Postoperative Analgesia in Pediatric Tonsillectomy Patients: A Randomized, Double-Blind, Placebo-Controlled Study

“…13 There are numerous studies in which a local anesthetic has been applied to the tonsillar fossae in tonsillectomy. The local anesthetic is usually applied by infiltration.…”

Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain

“…It was noted that there was not a significant difference between the bupivacaine pre-and post-incisional groups in pain reduction, but there was a significant difference in these groups compared to the saline groups. This study did address the use of other analgesics (acetaminophen) when assessing the VAS score, but the researchers did not note doses or frequency of those analgesics, as they were looking at the pre versus post-incisional infiltration and if differences in post-operative pain was more effective in the pre-versus the post-incisional groups [30]. This study suggests that in tonsillectomy either pre-or-post-incisional infiltration of bupivacaine may produce a reduction in post-surgical pain when compared to the saline (control) group.…”

Atividade preemptiva da infiltração da incisão com ropivacaína a 0,75%, em pacientes submetidos à herniorrafia inguinal

“…In comparing pre and postoperative local anesthetics infiltration literature results are conflicting. A study testing pre and postoperative bupivacaine infiltration in tonsillectomies has not found differences in analgesic control 22 . Similarly, a different study has not found pain intensity differences after mastectomy with pre or postoperative incision infiltration 23 .…”