Comparative analysis of local infiltration of tonsillar fossa with bupivacaine versus dexamethasone on post tonsillectomy morbidity

Abstract

Background: Tonsillectomy is one of the most common surgery performed in pediatric otorhinolaryngology. Pain and vomiting being the usual morbidity following this surgery. Aim & Objective: To compare the efficacy of infiltration of Bupivacaine versus dexamethasone into the tonsillar fossa in postoperative pain and vomiting. Methods: A total of 100 patients, aged 10-30 years of both sexes with chronic tonsillitis accrued into the study. They were divided in to two groups A and B. Group A was infiltrated with 0.5% bupivacaine (1mg/kg body weight) locally and Group B with dexamethasone (0.15mg/kg bodyweight) locally into the tonsillar bed. All patients underwent tonsillectomy by dissection/snare technique, bleeding was controlled by applying local pressure, and by ligatures, thereby avoiding cauterization. Post tonsillectomy pain assessed by visual analog scale (VAS), nausea and vomiting by absence/presence was compared between both groups. Results: In Bupivacaine group (A), 86% patients observed analgesic effect by the 1 st postoperative hour and by 6 th hour all had complete analgesia. In dexamethasone group (B) the analgesic effect started by 12 th hour and by 48 th hour in all patients (p<0.001). Post-operative occurrence of nausea and vomiting in bupivacaine group (A) was 76% and 30% respectively. However, in dexamethasone group (B), the nausea and vomiting was observed in 10% respectively. Conclusion: Our study showed that 0.5% bupivacaine reduces immediate post-operative pain significantly as compared to dexamethasone and dexamethasone reduces postoperative nausea and vomiting significantly as compared to 0.5% bupivacaine. There were no adverse reactions or complications due to the additional surgical intervention in both the groups.