Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation

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

“…The common method of providing postoperative analgesia is systemic administration of narcotic analgesics, though these drugs have their own side effects [9]. Injection or topical administration of a local anesthetic agent is believed to decrease pain by producing pharmacological blockade of the sensory pathways before surgery, thus preventing the nociceptive impulses from reaching the spinal cord [5,6,7,[14][15][16][17][18][19][20][21][22].…”

“…In some studies it is stated that levobupivacaine has similar anesthetic effect and duration, with less side effects [21,32]. There are only three studies [14,20,21], that we encountered, investigating the effects of levobupivacaine on post-tonsillectomy pain. Yilmaz et al [14] also used levobupivacaine after tonsillectomy, but they preferred topical administration through compression with levobupivacaine soaked swabs.…”

“…Karaaslan et al [20] reported that post-tonsillectomy injection of both levobupivacaine and levobupivacaine with magnesium reduced the pain scores and magnesium also contributed to decrease additional analgesic consumption. Tas et al [21] suggested that preincisional injection of levobupivacaine with epinephrine decreases early postoperative pain in children undergoing adenotonsillectomy, through an intraindividual study. We added 1/200,000 epinephrine to levobupivacaine and we injected levobupivacaine before onset of tonsillectomy as in Tas et al's [21] study.…”

“…be less cardio-and neurotoxic. However, a few studies showed that peritonsillar infiltration of levobupivacaine reduce the intensity of postoperative pain [20,21]. Furthermore, there is no randomized controlled clinical study on tonsillectomy pain, comparing both agents (bupivacaine and levobupivacaine).…”

Postoperative Pain in Children

“…Best results have been obtained at tonsillectomy operations. Ropivacaine administered to the tonsillar area before the operation has been shown to be effective in postoperative pain treatment [41]. Central sensitization at the brain stem level due to vagal stimulation of the peritoneum in hernia repair and appendectomy operations means that subcutaneous local anesthetic infiltration does not provide preemptive analgesia.…”