Topical bupivacaine in paediatric day-case tonsillectomy: a prospective randomized controlled trial

Abstract

Post-operative pain and delayed oral intake are common reasons for failure of discharge in day-case tonsillectomy. A double blind prospective randomized study was devised to investigate the effectiveness of topical bupivacaine in reducing post-operative pain in paediatric day-case tonsillectomy. Ninety-nine patients aged between three and 16 years were recruited into the study. One group received bupivacaine soaked swabs tightly packed in their tonsillar fossae while the control group received saline-soaked swabs. The bupivacaine group was found to drink (p < 0.001) and eat (p = 0.006) earlier than the control group. The pain scores at one (p < 0.001), three (p < 0.001) and six (p < 0.001) hours post-operatively were also found to be lower in the bupivacaine group than the control group. We conclude that topical bupivacaine has a role in facilitating recovery in day-case tonsillectomy in children.

Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?

“…Post-tonsillectomy pain in children remains as the most difficult management problem [2] and regarded as the primary cause of discharge failure [3]. Many treatment modalities for post-tonsillectomy pain have been used, ranging from systemic opioids to different surgical techniques [4,5].…”

“…Violaris and Tuffin [19] did not find any benefit of topical bupivacaine in decreasing post-operative analgesia in adult tonsillectomy. On the other hand, Hung et al [3] found that topical bupivacaine had some pain relieving effect in children following tonsillectomy. In Wong's study [20], peritonsiller infiltration of bupivacaine 0.5% with 1:200,000 epinephrine provided better post-tonsillectomy pain control in the immediate post-operative period than bupivacaine spray or placebo.…”

Pre-incisional infiltration for pediatric tonsillectomy: A randomized double-blind clinical trial

“…Despite the use of different surgical and anesthetic techniques in the search for safe and effective post-tonsillectomy pain relief, this problem remains a clinical dilemma [5][6][7][8][9][10][11][12][13][14].…”

Efficacy of bupivacaine for post-tonsillectomy pain: a study with the intra-individual design

“…Bupivacaine infiltration for post-tonsillectomy pain has been extensively studied [1][2][3][4][5][6][7][8][9][10], but its effect remains to be controversial. The previous studies evaluating post-operative pain, use one of the two main study designs: descriptive pain scale (DPS), and visual analog scale (VAS).…”

“…The DPS method was developed by Broadman et al [1]. In this study design a blinded observer decides who has more pain, comparing the patients after tonsillectomy [1][2][3][4]. Broadman et al [1], Stuart et al [2] and Kountakis [3] reported no difference between the study and control groups where Hung et al [4] reported better oral intake and less pain in the bupivacaine group.…”