Post-tonsillectomy pain control with pre-incisional infiltration of bupivacaine
Background and objective: Tonsillectomy is one of the most common surgeries, and post-operative pain is one of the most common inevitable sequel. Although various post-operative analgesia are used, pain is still an issue needed to be handled more thoroughly to gain early oral intake, less hospital stay, and early return to normal life. Thus, efforts are made to employ pre-emptive analgesia and achieve more relief. This study evaluated the effectiveness of pre-incisional peri-tonsillar (subcapsular) infiltration of bupivacaine in decreasing the post-tonsillectomy pain.
Methods: The study design is a prospective single-blinded controlled intra-individual study wielding a convenience sample of 45 patients of both genders, aged 14-40 years underwent tonsillectomy. Under general anesthesia, left tonsillar fossa infiltrated with 3cc of bupivacaine 0.5, leaving the other side free as a control side. After a wait time of 10 minutes while operating right side, left tonsillectomy done. post-operative pain was assessed using a visual analogue scale (VAS) on ½, 2, 4 and 6 hours pos-operatively.
Results: The mean age of the study participants was 24.44±6.959, and they included 29 (64.4) females and 16 (35.6) males. Seven patients (15.6%) showed no pain difference between left (test) side and right (control) side while 38 patients (84.4%) had a significant difference. The test side mean pain score was 1.01±0.64, and the control side mean pain score was 2.24±1.18 (P <0.001).
Conclusion: Infiltration of 3cc bupivacaine with a latent period of 10 minutes reduces the post-tonsillectomy pain by around two folds without any additional analgesia in the initial six hours.
Jahromi SA, Valami SM, Hatamian S. Comparison between effect of lidocaine, morphine and ketamine spray on post-tonsillectomy pain in children. Anesth Pain Med 2012; 2(1):17.
Peyvandi A, Roozbahany NA, Niknazar S, Mahani MH. Comparison of Peritonsillar Infiltration of Lidocaine and Bupivacaine for Management of Postoperative Pain of Tonsillectomy. J Otolarygol Facial Plast Surg 2016; 2(2):37–42.
Turhan KC, Salviz EA, Beton S, Timuroglu ST, Catav S, Ozatamer O. Peritonsillar infiltration with levobupivacaine for posttonsillectomy pain relief: does concentration have any effect? A double-blind randomized controlled clinical study. Eur Rev Med Pharmacol Sci 2015;19(7):1276–84.
Sharifian HA, Fathololoomi MR, Bafghi AF, Naini SA. Effect of local bupivacaine infiltration on post-tonsillectomy pain. Tanaffos 2006; 5(1):45–9.
Hydri AS, Malik SM. Posttonsillectomy pain and bupivacaine, an intra individual design study. J Coll Physicians Surg Pak 2010; 20(8):538–41.
Inanoglu K, Akkurt BC, Turhanoglu S, Okuyucu S, Akoglu E. Intravenous ketamine and local bupivacaine infiltration are effective as part of a multimodal regime for reducing post-tonsillectomy pain. Med Sci Monit 2009; 15(10):CR539–43.
Nikandish R, Maghsoodi B, Khademi S, Motazedian S, Kaboodkhani R. Peritonsillar infiltration with bupivacaine and pethidine for relief of post‐tonsillectomy pain: a randomised double blind study. Anaesthesia 2008; 63(1):20–5.
Medscape. Marcaine, Sensorcaine (bupivacaine) dosing, indications, interactions, adverse effects, and more. (Accessed February 15, 2018, at https://reference.medscape.com/drug/marcaine-sensorcaine-bupivacaine-343360).
Özkiriş M, Kapusuz Z, Saydam L. Comparison of ropivacaine, bupivacaine and lidocaine in the management of post-tonsillectomy pain. J Hear Sci Otolaryngol 2012; 76(12):1831–4.
Kasapoglu F, Kaya FN, Tuzemen G, Ozmen OA, Kaya A, Onart S. Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: placebo-controlled clinical study. Int J Pediatr Otorhinolaryngol 2011; 75(3):322–6.
Bameshki AR, Razban M, Khadivi E, Razavi M, Bakhshaee M. The effect of local injection of epinephrine and bupivacaine on post-tonsillectomy pain and bleeding. Iran J Otorhinolaryngol 2013; 25(73):209.
Park AH, Pappas AL, Fluder E, Creech S, Lugo RA, Hotaling A. Effect of perioperative administration of ropivacaine with epinephrine on post-operative pediatric adenotonsillectomy recovery. Arch Otolaryngol Head Neck Surg 2004; 130(4):459–64.
Ginström R, Silvola J, Saarnivaara L. Local bupivacaine–epinephrine infiltration combined with general anesthesia for adult tonsillectomy. Acta Otolaryngologica 2005; 125(9):972–5.
Grainger J, Saravanappa N. Local anaesthetic for post‐tonsillectomy pain: a systematic review and meta-analysis. Clin Otolaryngol 2008;33(5):411–9.
Kountakis SE. Effectiveness of perioperative bupivacaine infiltration in tonsillectomy patients. Am J Otolaryngol 2002; 23(2):76–80.
Amani S, Abedinzadeh MR. Effects of oral gabapentin, local bupivacaine and intravenous pethidine on post tonsillectomy pain. Iran J Otorhinolaryngol 2015; 27(82):343.
Solanki NS, Goswami M, Thaker N. Bupivacaine infiltration versus diclofenac suppository for post-tonsillectomy pain relief in paediatric patients. Nati J Med Res 2012; 2(1):5–7.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).