The Effect of Glossopharyngeal Nerve Block on Post-Tonsillectomy Pain of Children; Randomized Controlled Trial

Abstract

Background Sensory fibers of the glossopharyngeal nerve supply the tonsillar and peritonsillar areas. Thus, bilateral glossopharyngeal nerve block may alleviate post-tonsillectomy pain and improve postoperative analgesia. Objectives The purpose of this clinical trial was to evaluate the effect of glossopharyngeal nerve block on postoperative analgesia in children undergoing adeno-tonsillectomy Methods Ninety ASA I-II pediatric patients presented for adeno-tonsillectomy were included in this trial. They were equally divided and randomly assigned to one of two groups: A control group, in which children did not receive a nerve block, and a glossopharyngeal nerve block group, in which children received bilateral glossopharyngeal nerve block after surgery. The postoperative pain score (FLACC score) during rest and swallowing, the time for the first request for rescue analgesia, the total dose consumption of pethidine rescue analgesia, and the incidence of postoperative complications were all assessed. Moreover, response to gag reflex, degree of difficulty in swallowing, and parents’ satisfaction were recorded. Results Bilateral glossopharyngeal nerve block in children presented for adeno-tonsillectomy significantly prolonged the time for the first request of rescue analgesia, compared to the control group, reaching 5.833 ± 2.667 hours (P < 0.0001). It also decreased postoperative pethidine consumption to 0.878 ± 0.387 mg/kg (P = 0.0009). Moreover, it significantly decreased the postoperative FLACC score assessed two, four, six, and twelve hours after surgery, during rest and swallowing (P < 0.05). The response to gag reflex and difficulty in swallowing were also significantly decreased (P ≤ 0.0001 and 0.006, respectively). In addition, glossopharyngeal nerve block significantly increased parents’ satisfaction (P = 0.0002), with no significant increase in the incidence of postoperative complications (P > 0.05). Conclusions Bilateral glossopharyngeal nerve block in children undergoing adeno-tonsillectomy improved the duration and the quality of postoperative analgesia, decreased swallowing difficulties, and improved parents’ satisfaction.

PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

“…Glossopharyngeal nerve block demonstrated advantages over normal saline injection or no injection in four studies involving 315 patients [28][29][30][31]. Two studies reported severe complications.…”

Long-Term Follow-Up of Ultrasound-Guided Glossopharyngeal Nerve Block Treatment for Glossopharyngeal Neuralgia: A Retrospective Clinical Study of 43 Cases

“… 31 An ultrasound-guided block of the distal branch of the glossopharyngeal nerve in the parapharyngeal space is commonly used to treat oral and lingual diseases or pain resulting from surgery. 32 , 33 However, if the block is positioned lower than the glossopharyngeal nerve trunk, the ultrasound-guided parapharyngeal block may be less effective in treating classical GPN conditions. For ultrasound-guided glossopharyngeal nerve trunk blocks, the styloid process often serves as a localization marker.…”

Nerve Blocks of the Head and Face � An Interactive Review of Techniques and Clinical Cases

“…The block of this nerve is useful in diagnosing and differentiating glossopharyngeal neuralgia from trigeminal neuralgia. The intra oral approach to block is being used for perioperative pain relief in tonsillectomies 19 . Techniques: Extra oral approach: This approach can be facilitated by the use of ultrasound 20 (Figure 12).…”