Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores—A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Abstract

Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Efficacy of bupivacaine infiltration for controlling post‑tonsillectomy pain, duration of surgery and post‑operative morbidities: A systematic review and meta‑analysis

“…Of these, 379 patients (122 females and 167 males) received bupivacaine and 331 patients (130 females and 141 males) received normal saline (control group). Furthermore, two studies did not define or mention the patients' sex distributions ( 28 , 30 ). The mean age of all the patients was 9.1±5.6 years.…”

“…The mean age of the patients in the bupivacaine and the control group was 9.1±6.4 and 8.8±4.9 years, respectively. However, two studies reported only the overall mean age of their sample ( 28 , 30 ).…”

“…Due to the complex anatomy of the pharyngeal segments and their prominent vasculature, tonsillectomy represents a challenge for otolaryngologists worldwide ( 54 , 55 ). The traumatic nature of the procedure increases the likelihood of widespread intra-operative and post-operative morbidities ( 18 , 30 , 31 , 33 ). To counteract these side effects, bupivacaine has been increasingly recommended during tonsillectomies due to its superior antinociceptive properties and its ability to reduce vascular permeability and inflammation ( 22-24 , 48 ).…”

“…during tonsillectomy to reduce intra-operative and post-operative complications. Certain studies have recommended the administration of bupivacaine during rhinoplasty due to its ability to prevent intra-operative and post-operative complications (28)(29)(30)(31). Previous studies, particularly meta-analyses (18), have failed to provide conclusive evidence to support bupivacaine application during tonsillectomies.…”

“…The present review includes, for the first time, a detailed analysis of the isolated efficacy of bupivacaine to improve intra-operative factors associated with tonsillectomy such as the duration of the operative procedure. Since the publication of the last meta-analysis on this subject, several high-quality randomized controlled trials (RCTs) have been published, evaluating the efficacy of bupivacaine to improve intra-operative and post-operative morbidities associated with tonsillectomy (28)(29)(30)(31)(32)(33)(34)(34)(35)(36). The present systematic review and meta-analysis aimed to provide an updated evaluation of the effects of bupivacaine on operative and post-operative outcomes associated with tonsillectomy.…”