Local Bupivacaine Infiltration to Reduce Pain after Tonsillectomy: A Low Cost Approach

Main Article Content

Rakesh B S
Bharathi M B
Thanzeemunisa U
Kumar Shankar De
Nitish Aggarwal

Abstract

Introduction


Tonsillectomy is one of the most commonly performed surgical procedures worldwide, with the major drawback of significant post operative pain.There is no consensus regarding topical application or local infiltration of anesthetics post operatively to reduce pain. The present study was performed to evaluate the effect of bupivacaine infiltration in the tonsillar fossae after tonsillectomy.


Materials and Methods


A double-blinded clinical trial was performed on 75 patients undergoing tonsillectomy between January 2019 and January 2020. All patients underwent tonsillectomy under general anesthesia and were then randomly divided into 3 groups of 25 patients each. For Group I, a swab soaked in normal saline was applied to the tonsillar fossae for 5 minutes just before extubation. In Group II, a swab soaked in 5 ml of 0.5% bupivacaine was placed for 5 minutes, while in Group III, 5ml of 0.5% bupivacaine was infiltrated in the tonsillar fossae. The intensity of pain for each group was measured in the immediate post op period, at6 hours, 24 hours and 1 week by Wong Baker Faces Pain Rating Scale.


Results


There was a significant difference in the mean level of pain between groups I and III in the immediate post op period, at 6 hours and 24 hours. Although the average pain scores of group III were better than those of group II, the results were significant only in the 6 hour post op period.


Conclusion


To reduce post-tonsillectomy pain,0.5% bupivacaine can be infiltrated into the tonsillar fossa.

Article Details

How to Cite
1.
S RB, B BM, U T, De KS, Aggarwal N. Local Bupivacaine Infiltration to Reduce Pain after Tonsillectomy: A Low Cost Approach . BJOHNS [Internet]. 2021Feb.5 [cited 2024Apr.29];28(3):228-33. Available from: https://bjohns.in/journal3/index.php/bjohns/article/view/318
Section
Main article
Author Biographies

Rakesh B S, JSSAHER

Assisstant Professor in ENT

Bharathi M B, JSSAHER

Professor in ENT

Thanzeemunisa U, JSSAHER

Senior Resident in ENT

Kumar Shankar De, JSSAHER

Post Graduate in ENT

Nitish Aggarwal, JSSAHER

Post Graduate in ENT

References

Ohlms LA. Injection of local anesthetic in tonsillectomy. Archives of Otolaryngology–Head & Neck Surgery 2001; 127(10):1276-8

Lavy JA. Post-tonsillectomy pain: the difference between younger and older patients. International Journal of Pediatric Otorhinolaryngology 1997; 42(1):11-5

Afman CE, Welge JA, Steward DL. Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngology-Head and Neck Surgery 2006;134(2):181-6

Businco LD, Tirelli GC. Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures. Acta Otorhinolaryngologica Italica 2008; 28(2):67

Özköse Z, Akçabay M, Kemaloğlu YK, Sezenler S. Relief of posttonsillectomy pain with low-dose tramadol given at induction of anesthesia in children. International Journal of Pediatric Otorhinolaryngology. 2000; 53(3):207-14

Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, Auboyer C. Effect of pre‐vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiologica Scandinavica 1996; 40(10):1210-5

Jebeles JA, Reilly JS, Gutierrez JF, Bradley Jr EL, Kissin I. The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain 1991; 47(3):305-8

Tripathi KD. Essentials of medical pharmacology. JP Medical Ltd; 2013

Safavi NS, Sharifian H, Fath AM, Fatahi BA. Effect of local bupivacaine infiltration on post-tonsillectomy pain. TANAFFOS 2006; 5(1)(17):45-9

Hung T, Moore-Gillon V, Hern J, Hinton A, Patel N. Topical bupivacaine in paediatric day-case tonsillectomy: a prospective randomized controlled trial. The Journal of Laryngology and Otology 2002;116(1):33

Johansen M, Harbo G, Ilium P. Preincisional infiltration with bupivacaine in tonsillectomy. Archives of Otolaryngology–Head & Neck Surgery 1996;122(3):261-3

Jebeles JA, Reilly JS, Gutierrez JF, Bradley Jr EL, Kissin I. The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain 1991; 47(3):305-8

García A, MT LG. Intraoperative infiltration of 0.5% bupivacaine in pediatric tonsillectomy. Acta Otorrinolaringologica Espanola 1997; 48(4):287-90

Wong AK, Bissonnette B, Braude BM, Macdonald RM, St-Louis PJ, Fear DW. Post-tonsillectomy infiltration with bupivacaine reduces immediate postoperative pain in children. Canadian Journal of Anaesthesia 1995; 42(9):770-4

Kountakis SE. Effectiveness of perioperative bupivacaine infiltration in tonsillectomy patients. American Journal of Otolaryngology 2002; 23(2):76-80

Schoem SR, Watkins GL, Kuhn JJ, Alburger JF, Kim KZ, Thompson DH. Control of early postoperative pain with bupivacaine in adult local tonsillectomy. Archives of Otolaryngology–Head & Neck Surgery 1993; 119(3):292-3

Stuart JC, MacGregor FB, Cairns CS, Chandrachud HR. Peritonsillar infiltration with bupivacaine for paediatric tonsillectomy. Anaesthesia and Intensive Care 1994; 22(6):679-82

Schoem SR, Watkins GL, Kuhn JJ, Thompson DH. Control of early postoperative pain with bupivacaine in pediatric tonsillectomy. Ear, Nose & Throat Journal 1993; 72(8):560-3

Nordahl SH, Albrektsen G, Guttormsen AB, Pedersen IL, Breidablikk HJ. Effect of bupivacaine on pain after tonsillectomy: a randomized clinical trial. Acta Oto-laryngologica 1999; 119(3):369-76

Shipton EA. Tramadol—present and future. Anaesthesia and Intensive Care 2000; 28(4):363-74

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, Lloyd RM. Clinical practice guideline: tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery 2019; 160(1_suppl):S1-42

Nunez DA, Provan J, Crawford M. Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy—a randomized trial. Archives of Otolaryngology–Head & Neck Surgery 2000; 126(7):837-41

Leinbach RF, Markwell SJ, Colliver JA, Lin SY. Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngology—Head and Neck Surgery 2003; 129(4):360-4

Mösges R, Hellmich M, Allekotte S, Albrecht K, Böhm M. Hemorrhage rate after coblation tonsillectomy: a meta-analysis of published trials. European Archives of Oto-Rhino-Laryngology 2011; 268(6):807-16

Carney AS, Harris PK, MacFarlane PL, Nasser S, Esterman A. The coblation tonsillectomy learning curve. Otolaryngology–Head and Neck Surgery 2008; 138(2):149-52

Windfuhr JP. Studienzur Coblation-Tonsillektomie. HNO 2007; 55(5):337-48

Karimi E, Safaee A, Bastaninejad S, Dabiran S, Masoumi E, Salehi FM. A Comparison between Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy. Iranian Journal of Otorhinolaryngology 2017; 29(95):313

Yi Wong DJ, Paddle P. Harmonic scalpel versus other techniques for tonsillectomy: a systematic review and meta-analysis. Australian Journal of Otolaryngology. 2019; 23;2

Arbin L, Enlund M, Knutsson J. Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study. European Archives of Oto-Rhino-Laryngology 2017; 274(5):2281-5

Bean-Lijewski JD. Glossopharyngeal nerve block for pain relief after pediatric tonsillectomy: retrospective analysis and two cases of life-threatening upper airway obstruction from an interrupted trial. Anesthesia & Analgesia 1997; 84(6):1232-8.