Effect of Topical Bupivacaine on Post-Tonsillectomy Pain Relief in Children Referred to Ahvaz Imam Khomeini Hospital in 2013

Abstract

Background: Tonsillectomy is a common pediatric surgery followed by a severe, sometimes debilitating, postoperative pain. Many drugs can be used to control pain. Objectives: This study aimed to investigate the effects of topical bupivacaine in controlling postoperative pain. Patients and Methods:This clinical trial was performed on 60 elective tonsillectomy patients in Imam Khomeini Hospital, Ahvaz, in 2013. The patients were randomly divided into two groups of A and B; Group A received topical bupivacaine just before the operation, while Group B received placebo (distilled water). The results were statistically analyzed using SPSS-19. Results: Patients aged 4 to 13 years. The amount of postoperative pain was obviously less in the bupivacaine group than the other group. The mean time of postoperative fluid intake was lower in group A (bupivacaine) than Group B (placebo) (P < 0.001). The mean pain score at 24 hours after the operation was lower in the bupivacaine group than the placebo group (P < 0.001). Conclusions: Considering that tonsillectomy is one of the most common surgeries in children and produces a lot of pain, using a low risk medicine such as bupivacaine to recover child as soon as possible seems reasonable.

Effect of topical bupivacaine on post-tonsillectomy pain relief in children

“…Our study was able to demonstrate a significant difference in duration before the first request for systemic analgesics in the bupivacaine group when compared to the saline group p=0.006. In agreement with the above finding Saki et al 16 also found the bupivacaine group to have spent longer time before requesting for analgesics (P=0.002) when compared to the placebo group which further shows the systemic analgesic sparing effect of topical bupivacaine after tonsillectomy surgery in children.…”

“…This contrasting finding can be attributed to the surprisingly higher pain score (>7) that was set as cut off mark for rescue analgesic administration as against a pain score of >4 used in our study and by most other studies. [2][3][4][5]9,13,15,16 It is worthy to note that none of the patients in Group B had bupivacaine toxicity, which compares favourably with similar studies 2,4,5,9,16 where bupivacaine soaked gauze was topically applied in the tonsillar fossa after tonsillectomy in children.…”

“…Overall this present study has been able to demonstrate an improvement in pain control with topical application of bupivacaine, similar to that found in other studies. 2,4,13,16…”