The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia

Abstract

The aim of the present study was to test the hypothesis that blockade of nociceptive input with bupivacaine during tonsillectomy can decrease pain beyond the immediate postoperative period. Fourteen patients between the ages of 6 and 18 years scheduled for tonsillectomy (with or without adenoidectomy) were randomly divided into two groups. The patients of both groups received 0.006 mg/kg atropine and anesthesia was induced by inhalation of halothane. Atracurium 0.5 mg/kg was used for myorelaxation. After oral intubation anesthesia was maintained with isoflurane plus nitrous oxide 67% in oxygen. In the bupivacaine group, 5 min before incision the tonsillar fossae were infiltrated with 0.25% bupivacaine with epinephrine (1 : 200,000). In the control group, the tonsillar fossae were infiltrated with normal saline with epinephrine (1 : 200,000). All patients received morphine 0.07 mg/kg (in the recovery room) and oral elixir with codeine 0.05 mg/kg plus acetaminophen 5 mg/kg every 4 h. Pain assessments were made using the visual analog (100 mm scale) self-rating method. Two types of pain were assessed: constant incisional pain and pain caused by drinking 100 ml of water. In the bupivacaine group, the constant pain score on the second day after surgery was 19 +/- 6 compared to 74 +/- 8 in the saline group (P less than 0.0002). By the 4-5th day after surgery almost no constant pain occurred in the bupivacaine group, but the pain score remained at the 40-60 level in the saline group. The difference in pain intensity on swallowing between the bupivacaine and saline groups was present even on the 10th postoperative day (1 +/- 1 vs. 14 +/- 5, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy

“…Some studies report that protecting the nervous system from the noxious insults of surgery, using regional analgesic techniques, results in blunting of the neuroendocrine response and reduces postoperative pain. [16][17][18][19] Raja et alused epidural anesthesia, which may have reduced postoperative pain by attenuating spinal cord hyperexcitability. [20][21] Sørensen et al showed that additional local anesthesia, intra-articular bupivacaine after intra-articular lidocaine, did not improve postoperative analgesia.…”

Greater occipital nerve blockade in cervicogenic headache

“…This phenomenon, known as "wind-up", is characterized by a time-dependent increase in spinal cord responsiveness to subsequent afferent input and underlies the phenomenon of secondary hyperalgesia 19 . This may explain post-operative pain reduction when C-fibre neurotransmitters release at the dorsal horn is prevented by regional anaesthetic procedures 20 .…”

Analgesia com laser terapêutico após tonsilectomia

“…Comparisons between different techniques employed for the surgical removal of tonsils, anesthetic or corticosteroid injections in the peritonsillar space, and use of antibiotics postoperatively are resources which have been used aiming to relieve pain and improve the patient's quality of life (3)(4)(5)(6)(7)(8) . Adenotonsillectomy is an easy procedure to perform from a technical point of view that brings almost immediate benefits, in relation to breathing improvement in children, in cases of palatine tonsil and adenoid hypertrophy.…”

“…Several studies in the literature refer to intraoperative local anesthetic infiltration in the tonsillar fossae to reduce odynophagia after tonsillectomy (4)(5)(6)(7)(8) . Since the 1970s, Laser (Light Amplification by Stimulated Emission of Radiation) has been widely used in medical practice serving several purposes.…”