Peritonsillar Infiltration with Bupivacaine for Paediatric Tonsillectomy

Abstract

In a double-blind study forty-two children scheduled for elective adenotonsillectomy were randomized to receive peritonsillar infiltration, following induction of anaesthesia, with either 0.25% plain bupivacaine or 0.9% saline, 0.5 mllkg to a maximum of 10 ml. The children were assessed on awakening, and then ID minutes, I hour, 4 hours and 24 hours later. On each occasion the observer gave the child a pain score from 1 (no pain) to 5 (severe pain). The scores on awakening and after 10 minutes were significantly lower in the bupivacaine group (P< 0.05, Mann-Whitney U test). Thereafter there was no difference between the groups. The authors conclude that peritonsillar infiltration with bupivacaine is only moderately useful as analgesia for children having tonsillectomy.

The effects of topical levobupivacaine on morbidity in pediatric tonsillectomy patients

“…On the contrary, some studies concluded that bupivacaine infiltration has no or little effect on postoperative pain. While Broadman et al were unable to show any differences between infiltrations of epinephrine containing bupivacaine and normal saline solutions in terms of postoperative pain scores, Stuart et al found a significant reduction only at postoperative tenth minutes in their clinical trial with the same solutions [25,26]. Egeli and Akkaya did not find any statistically significant difference in postoperative complications and pain control between dexamethasone infiltrated group and the group of placebo with saline at the peritonsillar region [27].…”

Efficacy of bupivacaine for post-tonsillectomy pain: a study with the intra-individual design

“…Bupivacaine infiltration for post-tonsillectomy pain has been extensively studied [1][2][3][4][5][6][7][8][9][10], but its effect remains to be controversial. The previous studies evaluating post-operative pain, use one of the two main study designs: descriptive pain scale (DPS), and visual analog scale (VAS).…”

“…The DPS method was developed by Broadman et al [1]. In this study design a blinded observer decides who has more pain, comparing the patients after tonsillectomy [1][2][3][4]. Broadman et al [1], Stuart et al [2] and Kountakis [3] reported no difference between the study and control groups where Hung et al [4] reported better oral intake and less pain in the bupivacaine group.…”

Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: Placebo-controlled clinical study

“…However, some trials concluded that bupivacaine infiltration has no or little effect on postoperative pain. Stuart et al [27] found significant reduction only at postoperative 10th minutes in their clinical trial with infiltration of epinephrine containing bupivacaine. Recently, a meta analysis by Sun et al [28], concluded that peri-operative bupivacaine infiltration is a safe and effective method for relief of pediatric post-adenotonsillectomy pain.…”