Rectal acetaminophen versus peritonsillar infiltration of bupivacaine for postoperative analgesia after adenotonsillectomy in children

Abstract

There are a wide range of analgesic methods used for postoperative pain control in children undergoing elective adenotonsillectomy and there are many cases in which the postoperative analgesic modalities have not been fully successful to treat pain effectively. The acute postoperative analgesic effects of peritonsillar bupivacaine infiltration compared with rectal acetaminophen suppositories in elective adenotonsillectomy have been compared here. The methods employed were a single blind randomized clinical trail where 110 cases were selected to enter the study. After induction of anesthesia and intubation, and just before start of the procedure, the 1st group received 30 mg/kg of acetaminophen rectally; while, the 2nd group received 1 mg/kg peritonsillar bupivacaine infiltration around the tonsils. Throat pain at rest, after swallowing, after taking fluid and after soft food and also, parents' and nurses satisfaction regarding patient analgesia were compared. The results stated that there was no difference between the two groups regarding throat pain at rest, after swallowing, after taking fluid and after soft food and also, parents' and nurses' satisfaction. We concluded that when considering the feasibility of rectal acetaminophen, the results of the study suggest it superior due to minimal risks compared with local peritonsillar administration of bupivacaine for elective adenotonsillectomy of children.

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

“…164 • Local wound infiltration by the surgeon of a long-acting local anesthetic. 60,139,[165][166][167][168][169] • Intravenous fentanyl or morphine or other suitable agent (if available) to treat breakthrough pain in the PACU 51,[170][171][172] • Oral NSAIDs and/or paracetamol in adequate dosage during the entire postoperative period from the moment when the oral intake will be possible. 173,174 • Intravenous or oral tramadol or other suitable agent if available as rescue in the ward.…”

A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy

“…A total of 189 randomized controlled and comparison trials met the inclusion criteria for analysis 18–206 . A PRISMA diagram outlining the literature search is shown in Figure 1, and the risk of bias graph is shown in Figure 2.…”

“…A total of 189 randomized controlled and comparison trials met the inclusion criteria for analysis. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ...…”

The analgesic Efficacy and Safety of Topically Applied Tramadol in Peritonsillar Space During Pediatric Adenotonsillectomy: A Meta-Analysis

“…4,5 However, if a deep injection or a high dose is administered, it may cause vasoconstriction leading to serious complications such as vocal cord paralysis or facial nerve paralysis. 3,[37][38][39] Several studies have reported that dexamethasone reduces postoperative pain and time to food intake. 40,41 However, some reported that dexamethasone injection did not show significant postoperative pain reduction but reduced nausea and vomiting.…”

“…4,5 However, if a deep injection or a high dose is administered, it may cause vasoconstriction leading to serious complications such as vocal cord paralysis or facial nerve paralysis. 3,37 -39…”