Role of Bupivacaine in reducing post tonsillectomy pain

BackgroundAn effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice.ObjectivesThe goal of this study was to compare the analgesic effects of the spray forms of; lidocaine, morphine, ketamine, and normal saline on post-tonsillectomy pain scores in children.Patients and MethodsA total of 120 children, American Society of Anesthesiologist (ASA) class I–II, scheduled for elective tonsillectomy were enrolled in this double-blind, clinical trial study. They were randomly divided into 4 groups, each receiving one of the following drugs at the end of operation; lidocaine spray (2 mg/kg); morphine spray (0.05 mg/kg); ketamine spray (0.5 mg/kg); or normal saline spray (8 puffs). For comparison of postoperative pain; the face, legs, activity, cry, consolability (FLACC) pain scale was evaluated during the first one hour of recovery period at 20 minutes intervals. The data was transferred to SPSS-10 software and analyzed statistically with the Scheffe test and Dunnett’s T3 test. P value less than 0.05 was considered significant.ResultsIn the early postoperative period (time: 0) and at 20, 40 and 60 minutes of recovery time, FLACC scale scores in the control group were higher than in the three other groups. At 20 minutes, the FLACC scale score in the lidocaine group was lower than in the other groups. At 40 minutes, the statistical differences between FLACC scales of the lidocaine, morphine and ketamine groups were not significant (P > 0.05). Finally, at 60 minutes, the FLACC scale scores of the ketamine and morphine groups were lower than in the other groups.ConclusionsThe results of this study showed that lidocaine spray had the best pain controlling effect at 20 minutes in the recovery room, but after 40 minutes, ketamine and morphine sprays were more effective than the lidocaine spray.

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“…Also excessive dissection and use of cautery-hemostasis may produce an even larger amount of inflammation and post-operative pain (20). …”

Section: Discussionmentioning

confidence: 99%

“…Tonsillectomy produces large areas of exposed muscle in the oropharynx, resulting in considerable pain from muscle spasm and irritation of the nerve endings. Also excessive dissection and use of cautery-hemostasis may produce an even larger amount of inflammation and post-operative pain ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Effect of Lidocaine, Morphine and Ketamine Spray on Post-Tonsillectomy Pain in Children

2012

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“…1 Even Kermat Mozafowinia and Marym Amizadeh [9] showed similar results in reduction of post-operative pain in bupivacaine infiltration group. Moreover, Bhadoria P et al (2006) [10] also found that bupivacaine group had significant reduction in post-operative pain.…”

Section: Discussionmentioning

confidence: 91%

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

Aruna

Sukthankar

Raga

2019

Trop J Ophthalmol Otolaryngol

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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.

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“…11 Excessive dissection and use of cautery hemostasis during tonsillectomy may produce greater incidence of inflammation and postoperative pain. 12 Patients with Post-tonsillectomies often complain ear pain, presumably referred otalgia which occur via glossopharyngeal nerve. Removal of the tonsil triggers the inflammatory process which facilitates the healing at the tonsillar fossa area but also leaves an open wound which exposes the nerve fibers and damaged muscle fibers.…”

Section: Of Post-tonsillectomy Painmentioning

confidence: 99%

Post-tonsillectomy pain management in pediatric patients-a review

Swain

2021

Int J Contemp Pediatr

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Tonsillectomy is a common surgical procedure performed in the pediatric age group. Although tonsillectomy is a safe surgery, it is associated with significant post-operative pain. Analgesia after tonsillectomy is often inadequate. Severe post-tonsillectomy throat pain has been described for more than a decade. Parents often worry for handling the pain of their children in home. Post-tonsillectomy pain is often considered as a long lasting and intense in nature. Post-tonsillectomy pain in children is an important problem which overstrains the patient, family and hospital staff. Post-tonsillectomy pain in children is an important problem which overstrains the patient, family and hospital staff. Regulatory alteration in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more difficult. Post-tonsillectomy pain in pediatric patients continues to be highly debated clinical issue and also an area of active research. Post-tonsillectomy pain can result in significant morbidity among pediatric patients. There are several analgesics available; each one has its own risk profile and unique side effects when used in pediatric age group in post-tonsillectomy period. This review article provides an update on recent management of post-tonsillectomy pain in pediatric patients. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain in children and details of medications used for controlling post-tonsillectomy pain.

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Role of Bupivacaine in reducing post tonsillectomy pain

Cited by 8 publications

References 5 publications

Comparison Between Effect of Lidocaine, Morphine and Ketamine Spray on Post-Tonsillectomy Pain in Children

Comparison Between Effect of Lidocaine, Morphine and Ketamine Spray on Post-Tonsillectomy Pain in Children

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

Post-tonsillectomy pain management in pediatric patients-a review

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