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Efficacy of Levobupivacaine Versus Levobupivacaine Plus Dexmedetomidine Infiltration for Post-Tonsillectomy Analgesia: A Randomized Controlled Trial. Pain Res Manag 2022; 2022:9958668. [PMID: 36247104 PMCID: PMC9553655 DOI: 10.1155/2022/9958668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Background. The study evaluated the analgesic effects of levobupivacaine infiltration in the tonsil bed, and a combination of levobupivacaine and dexmedetomidine in patients undergoing tonsillectomy. Methods. Ninety children (ages 3 to 7 years) who were scheduled for a tonsillectomy were allocated randomly into two groups. (L Group): peritonsillar infiltration with 0.25% levobupivacaine (2 ml + 0.5 ml saline 0.9% per tonsil). (LD Group): levobupivacaine 0.25% (2 ml) plus dexmedetomidine 1 μg/kg diluted in 1 ml saline 0.9% (0.5 ml in each tonsil), and administered by peritonsillar infiltration (2.5 ml per tonsil) following intubation 3–5 minutes before operation. To avoid bias, infiltrate a total volume of 2.5 ml in each tonsil. The first analgesic request time was the primary outcome, with postoperative pain score, total analgesic consumption, total oral intake, sedation, and side effects as secondary outcomes. Results. The first rescue analgesia time in the LD group was longer (644.31 ± 112.89 min) than in the L group (551.51 ± 146.16 min,
-value <0.001). The number of patients who required >1 analgesic dose in the L group (n = 13) was higher than in the LD group (n = 5). The LD group consumes a lower total dose of IV paracetamol in the first 24 hours postoperatively (321.89 ± 93.25 mg) than the L group (394.89 ± 183.71 mg,
-value < 0.050). On the first day postoperatively, patients in the LD group had a higher total oral intake (
). Except for a slight increase in laryngospasm in the L group, there were no side effects. Conclusions. The Children’s peritonsillar infiltration of levobupivacaine and dexmedetomidine improved postoperative pain after adenotonsillectomy. The topically applied levobupivacaine and dexmedetomidine were concomitant with no systemic effects, greater total oral intake on the first day postoperative, and higher family satisfaction.
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Shih MC, Long BD, Pecha PP, White DR, Liu YC, Brennan E, Nguyen MI, Clemmens CS. A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2022; 9:9-26. [PMID: 37006744 PMCID: PMC10050970 DOI: 10.1002/wjo2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. Data Sources PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). Methods A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain-related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. Results One hundred and eighty-nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual-assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self-comparisons. Conclusion Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta-analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively.
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Affiliation(s)
- Michael C. Shih
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Baylor College of Medicine Houston Texas USA
| | - Barry D. Long
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Department of Otolaryngology—Head and Neck Surgery Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - David R. White
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - Yi‐Chun C. Liu
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
- Department of Surgery ‐ Division of Pediatric Otolaryngology Texas Children's Hospital Houston Texas USA
| | - Emily Brennan
- Department of Research and Education Services Medical University of South Carolina Library Charleston South Carolina USA
| | - Mariam I. Nguyen
- Charleston County School of the Arts North Charleston South Carolina USA
| | - Clarice S. Clemmens
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
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Yap D, Ng M, Moorthy R. #10-Year Challenge: Local anaesthetic for post-tonsillectomy pain: Update meta-analysis. Clin Otolaryngol 2020; 45:517-528. [PMID: 32293106 DOI: 10.1111/coa.13547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/17/2020] [Accepted: 04/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adequate management of post-tonsillectomy pain is an important consideration in postoperative management after tonsillectomy. A 2008 meta-analysis showed that the use of local anaesthetic either by infiltration or topical application reduced postoperative pain. OBJECTIVES To review the current evidence for the use of local anaesthetic as a means of reducing post-tonsillectomy pain and compare current evidence to the previous meta-analysis 10 years ago. METHOD Systematic literature searches of MEDLINE [*"ANESTHETICS, LOCAL"/ AND *TONSILLECTOMY/], EMBASE [*"LOCAL ANESTHETIC AGENT"/ AND *TONSILLECTOMY/] and PubMed [(Tonsillectomy).ti,ab AND (Local Anaesthetic).ti,ab OR (Local Anesthetic).ti,ab]. A meta-analysis of randomised control trials assessing the use of local anaesthetic agents for post-tonsillectomy pain. RESULTS Twenty-three studies were included in the meta-analysis. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4-6 hours [-0.65 (95% CI: -0.77; -0.53)]; 24 hours [-0.50 (95% CI: -0.66, -0.35)]; and 5-7 days [-0.78 (95% CI: -0.90, -0.65)] (standardised mean differences). CONCLUSION Current studies suggest that use of peri-operative local anaesthetic during tonsillectomy does improve postoperative pain outcomes. The limitations of the analysis are as follows: all studies are small, and a multi-centred larger trial is recommended to guarantee statistical reliability. There was no description of significant adverse side effects from local anaesthetic use.
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Affiliation(s)
- Darren Yap
- ENT Department, Wexham Park Hospital, Slough, UK
| | - Miane Ng
- Royal Victoria Hospital, Belfast, UK
| | - Ram Moorthy
- ENT Department, Wexham Park Hospital, Slough, UK
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Junaid M, Halim MS, Onali MAS, Qadeer S, Khan HU, Ali NS. Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial. Int Arch Otorhinolaryngol 2019; 24:e62-e67. [PMID: 31892959 PMCID: PMC6828561 DOI: 10.1055/s-0039-1684037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/17/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.
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Affiliation(s)
- Montasir Junaid
- Department of Otolaryngology-Head and Neck Surgery, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudia Arabia
| | | | - Maisam Abbas Shiraz Onali
- Department of Otorhinolaryngology-Head and Neck Surgery, Jinnah Medical College and Hospital, Karachi, Pakistan
| | - Sadaf Qadeer
- Department of Otorhinolaryngology-Head and Neck Surgery, Sir Syed College of Medical Sciences for girls, Karachi, Pakistan
| | - Hareem Usman Khan
- Department of Cardiology, Shifa Intersternal Hospital, Islamabad, Pakistan
| | - Naeem Sultan Ali
- Department of Otolaryngology-Head and Neck Surgery, The Aga Khan Hospital, Dar-es-salaam, Tanzania
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Tolska HK, Takala A, Blomgren K, Hamunen K, Kontinen V. Topical Ropivacaine in Prevention of Post-Tonsillectomy Pain in Adults. Anesth Analg 2017; 124:1459-1466. [PMID: 28328759 DOI: 10.1213/ane.0000000000002015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Post-tonsillectomy pain is 1 of the most intense postoperative pain conditions. However, optimal and sufficient postoperative analgesic treatment remains unclear. We investigated the effect of topical ropivacaine for post-tonsillectomy pain in 160 adult outpatient surgery patients over 2 postoperative weeks. METHODS At the end of tonsillectomy, 2 swabs soaked in either 1% ropivacaine or saline were packed into the tonsillar beds for 5 minutes. We used ibuprofen and a combination of acetaminophen (500 mg)-codeine (30 mg) tablets as postoperative analgesics for 2 weeks. The primary outcome was pain intensity on swallowing measured on a numeric rating scale (NRSs) during the first postoperative week expressed as area under curve (AUC). The secondary endpoints included the worst pain experienced during the 2-hour follow-up in the postanesthesia care unit, pain intensity during the second postoperative week, and the number of ibuprofen and acetaminophen-codeine tablets consumed during the 2 postoperative weeks. RESULTS During the first postoperative week, 120 patients out of 160 (75%) provided complete results, including data on their use of analgesics according to the instructions as well as completed and returned a questionnaire daily. A total of 101 patients (63%) did the same during the second postoperative week.Median (interquartile range [IQR]) of the primary outcome NRSs (AUC) was 38 (19) for the ropivacaine group and 37 (24) for the control group during the first postoperative week (P = .77, -1.0 estimated difference; 95% confidence interval [CI] for the difference, -7.0 to 5.0); no difference was found. Median (IQR) of NRS at rest (NRSr) (AUC) was 24.5 (19) for the ropivacaine group and 24 (22) for the control group during the first postoperative week (P = .96, 0.0 estimated difference; 95% CI for the difference, -5.0 to 5.0); no difference was found. Median (IQR) of the worst pain intensity values (NRSs or NRSr) (AUC) was 5 (3) for the ropivacaine group and 5 (3) for the control group (P = .44, 0.0 estimated difference; 95% CI for the difference, -1.0 to 0.5); no difference was found. During the second postoperative week, median (IQR) of the NRSs (AUC) was 17 (13) for the ropivacaine group and 21 (23) for the control group (P = .05, -4.0 estimated difference; 95% CI for the difference, -9.0 to 0.0) and median (IQR) of the NRSr (AUC) 10.5 (10) for ropivacaine group and 11 (13) for the control group (P = .42, -1.0 estimated difference; 95% CI for the difference, -5.0 to 2.0); no difference was found.The number of rescue analgesics (acetaminophen-codeine tablets) consumed during the second postoperative week was lower in the ropivacaine group than in the control group (median [IQR] of the consumption [AUC] was 10 [12] for the ropivacaine group and 16 [12] for the control group; P = .0008, -7.0 estimated difference; 95% CI of difference, -10 to -3.0). The groups showed no differences in overall risk for post-tonsillectomy bleeding. However, bleeding requiring hemostasis under local anesthesia was more common in the ropivacaine group (18% vs 8%, P = .048, 10% estimated difference; 95% CI for the difference, 0%-21%). CONCLUSIONS Topical ropivacaine failed to reduce pain intensity during the first postoperative week. We observed no major adverse effects.
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Affiliation(s)
- Hanna Kaisa Tolska
- From the *Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, †Division of Otorhinolaryngology, Department of Head and Neck Surgery, and ‡Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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The Efficacy of Levobupivacaine Hydrochloride-Dexamethasone Infiltration for Post-Tonsillectomy Pain in Adults. J Craniofac Surg 2016; 26:e651-3. [PMID: 26468853 DOI: 10.1097/scs.0000000000001975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the study is to evaluate the efficacy of peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination for post-tonsillectomy pain in adult patients. METHODS A total of 40 patients were included in this double-blind, randomized, and placebo-controlled study. The patients were equally randomized into 2 groups by means of sealed envelopes. The study group (SG) received peritonsillar levobupivacaine hydrochloride and dexamethasone infiltration and the control group (CG) received peritonsillar saline infiltration. Pain scores at the second, fourth, eighth, 12th, 16th, and 24th hours and the second to seventh days after operation were recorded by the patients in each group using a visual analog scale. Duration of surgery and the total amount of blood loss during the surgery were also recorded for each patient. RESULTS All pain scores in the SG were lower than those in the CG; however, the difference was significant at the second, 12th, and 16th hours, and the second and third day (P < 0.05). Postoperative morbidity parameters, including otalgia, nausea, vomiting, fever, halitosis, and bleeding were similar between the 2 groups. Total amount of analgesic consumption in the SG was significantly lower than in the CG on each day of the week after tonsillectomy. CONCLUSIONS Peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination may provide pain reduction and decrease analgesic consumption in the postoperative period after adult tonsillectomy.
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Muderris T, Gul F, Yalciner G, Babademez MA, Bercin S, Kiris M. Oral Flurbiprofen Spray for Posttonsillectomy Pain. Otolaryngol Head Neck Surg 2016; 155:166-72. [PMID: 26980919 DOI: 10.1177/0194599816637865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 02/17/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy. STUDY DESIGN Prospective, double-blind, randomized, placebo controlled. SETTING Patients at Ataturk Training and Research Hospital, Ankara, Turkey. SUBJECTS AND METHODS This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected. RESULTS There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups. CONCLUSION In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications.
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Affiliation(s)
- Togay Muderris
- Department of Otorhinolaryngology, Head and Neck Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Fatih Gul
- Department of Otorhinolaryngology, Head and Neck Surgery, Bitlis Tatvan State Hospital, Bitlis, Turkey
| | - Gokhan Yalciner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Babademez
- Department of Otorhinolaryngology, Head and Neck Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Sami Bercin
- Department of Otorhinolaryngology, Head and Neck Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Muzaffer Kiris
- Department of Otorhinolaryngology, Head and Neck Surgery, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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El-Anwar MW, Mostafa K, Elsamad AA. Levobupivacaine Alone Versus Levobupivacaine Plus Magnesium Infiltration for Post-Tonsillectomy Analgesia. INT J PHARMACOL 2015. [DOI: 10.3923/ijp.2015.490.495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pre-emptive peritonsillar dexamethasone vs. levobupivacaine infiltration for relief of post-adenotonsillectomy pain in children: a controlled clinical study. Int J Pediatr Otorhinolaryngol 2014; 78:1467-71. [PMID: 24984928 DOI: 10.1016/j.ijporl.2014.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the effects of the pre-emptive local infiltration of dexamethasone vs. levobupivacaine on postoperative pain and morbidity in pediatric adenotonsillectomy patients. METHODS A total of 60 patients (32 males and 28 females), aged 3-14 years, were included in this double-blind prospective randomized controlled clinical study from September of 2011 until May of 2012. Patients admitted for adenotonsillectomies after informed consent was obtained from the parents, and randomized into three groups receiving either dexamethasone sodium phosphate (Group 1, mean age 5.9 ± 1.6), levobupivacaine with epinephrine (Group 2, mean age 6.1 ± 2.6), or saline (Group 3, mean age 6.0 ± 3.4). Pain scores at the 1st, 4th, 8th, 12th, 16th, and 20th hours, and first, second, third and seventh days post-operatively were recorded by the parents using McGrath's face scale. The operation type, operation time and anesthesia time, the time of the first request for postoperative analgesia, and the total number of analgesic interventions were recorded. RESULTS Pain scores were revealed in this order: Group 1 (steroid) < Group 2 (levobupivacaine) < Group 3 (saline) at all times (p = 0.000). The anesthesia times for Group 1 and Group 2 were different (steroid vs. levobupivacaine), and the time to first analgesic was longer in Groups 1 (steroid) and 2 (levobupivacaine) than in Group 3 (saline) (p < 0.000). The total number of analgesic interventions was lower in Group 1 (steroid) than in Group 2 (levobupivacaine) and Group 3 (saline) (steroid vs. saline, p = 0.000, and steroid vs. levobupivacaine, p < 0.05). CONCLUSION Peritonsillar dexamethasone infiltration was more effective than both levobupivacaine and saline in reducing post-tonsillectomy pain. It was proven to be a safe and effective method.
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Haksever M, Özmen S, Akduman D, Solmaz F. Topical bupivacaine compared to bupivacaine infiltration for post-tonsillectomy pain relief in children: a prospective randomized controlled clinical study. Eur Arch Otorhinolaryngol 2014; 271:2555-9. [DOI: 10.1007/s00405-014-3022-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/20/2014] [Indexed: 11/30/2022]
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Preoperative peritonsillar infiltration of dexamethasone and levobupivacaine reduces pediatric post-tonsillectomy pain: a double-blind prospective randomized clinical trial. J Anesth 2013; 27:844-9. [DOI: 10.1007/s00540-013-1638-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
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Ergil J, Akkaya T, Gozaydin O, Gunsoy B, Alicura S, Aladag E, Gumus H, Akin I. Vasoconstrictive and analgesic efficacy of locally infiltrated levobupivacaine in tonsillectomy patients. Int J Pediatr Otorhinolaryngol 2012; 76:1429-33. [PMID: 22776810 DOI: 10.1016/j.ijporl.2012.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/11/2012] [Accepted: 06/15/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The use of preincisional plain levobupivacaine, lidocaine adrenaline and saline for perioperative blood loss and postoperative analgesia in pediatric tonsillectomy patients are compared. METHODS Ninety patients were randomly assigned into one of the 3 groups to receive preincisional peritonsillar infiltration of levobupivacaine 0.25% (group LB), lidocaine-adrenaline 1% with 1:200,000 (group LA) and saline (group S) under general anesthesia. Intraoperative blood loss, pre- and postoperative hemoglobin (hb) and haematocrit (htc) values, hemostasis time, operation duration, number of cautery used (20 W, 1s) and heart rates were recorded. Pain scores in PACU, at 6th, 12th and 24th hours postoperatively and the number of the patients requiring analgesic treatment for first 24h was also recorded. RESULTS There was a 30% reduction in perioperative blood loss in group LB and 63% reduction in group LA compared to group S (39 ± 6, 21 ± 4 and 55 ± 7 ml respectively) (p<0.001). Even though all three groups have significantly lower postoperative hb and htc values with respect to preoperative levels both local anesthetic groups had significantly higher postoperative hb and htc values than saline (p<0.001). Time required for hemostasis, the number of cautery used for haemostasis and operation duration were lower in groups LB and LA with respect to group S. Pain scores of the group LB revealed a significantly lower score throughout 24h. Only 14 patients in group LB demanded additional analgesic where as all patients in the other groups had. Adding adrenaline to the local anesthetic solution showed no side effects. Also we did not happened to see any complications related to local anesthetic injections. There was no postoperative major bleeding in groups. CONCLUSION Levobupivacaine has a vasoconstrictive effect in 0.25% concentrations that may be beneficial in tonsillectomy patients and has a consistent analgesic effect.
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Affiliation(s)
- Julide Ergil
- Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Anesthesiology Departement, Turkey.
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The effects of levobupivacaine infiltration on post-tonsillectomy pain relief in adults: a single-blinded, randomized, and controlled clinical study. Eur Arch Otorhinolaryngol 2012; 270:761-6. [PMID: 23053376 DOI: 10.1007/s00405-012-2194-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
The aim of this prospective single-blinded and controlled study is to evaluate the efficacy of levobupivacaine infiltration on post-tonsillectomy pain relief in adults. The study was conducted with 40 adult patients who underwent tonsillectomy. These patients were randomized in either study group (SG) who received levobupivacaine infiltration to peritonsillary fossae prior to surgery or control group (CG) with no medication. After surgery, all the patients were queried for pain scores by visual analog scale. In addition, the volume of intraoperative bleeding, the duration of operation, the severity of postoperative complications, and the amount of analgesic requirement were the other outcome measures of this study. There were significant differences between groups regarding pain scores for the first 24 h in favor of SG. The analgesic requirement was also significantly lower in SG (p = 0.009). Although there was a sustained decrement at pain score during first 24 h for SG, however, the change from baseline score (immediate score) for each time interval revealed no significance compared to CG. In addition, the duration of operation and the volume of intraoperative bleeding were similar (p = 0.64 and p = 0.165). In conclusion, preincisional infiltration of levobupivacaine is a safe and reliable method for post-tonsillectomy pain reduction in adults. However, more in-depth, double-blinded and placebo controlled studies are required to elucidate its long term benefits.
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Kasapoglu F, Kaya FN, Tuzemen G, Ozmen OA, Kaya A, Onart S. Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: placebo-controlled clinical study. Int J Pediatr Otorhinolaryngol 2011; 75:322-6. [PMID: 21168923 DOI: 10.1016/j.ijporl.2010.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the effects of preincisional peritonsillar infiltration of levobupivacaine and bupivacaine on post-tonsillectomy pain in children. METHODS Sixty children undergoing elective tonsillectomy or adenotonsillectomy were randomly allocated into three groups before tonsillectomy: peritonsillar infiltrations with 0.25% levobupivacaine with 1:200,000 epinephrine (group levobupivacaine, n=20), 0.25% bupivacaine with 1:200,000 epinephrine (group bupivacaine, n=20), and normal saline (group saline, n=20) were applied. Pain was evaluated by using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS). Choice of additional analgesic was acetaminophen for all patients. RESULTS mCHEOPS values at 0th (immediately) and 30th minute after arrival the PACU were lower in both the local anesthetics groups than the saline group (p<0.001, p<0.01 for the group levobupivacaine; p<0.001, p<0.05 for the group bupivacaine, respectively). In addition, mCHEOPS values at 1st hour in the ward was lower in the group bupivacaine when compared to the group saline (p<0.05). Analgesic requirements and the time to first analgesia required, were also significantly different between the local anesthetic and saline groups (p<0.05 for both local anesthetics groups). Time to first mobilization was shorter in both local anesthetic groups when compared to the saline group (p<0.05 for both local anesthetic groups). CONCLUSION Preincisional peritonsillar infiltration with levobupivacaine or bupivacaine before tonsillectomy, are effective than saline, in reducing early post-tonsillectomy pain, where as bupivacaine had slightly longer effect. Compared to saline, with both anesthetic infiltrations, lesser medication for analgesia is required. The clinical trial registration number (Research Ethics Committee of Medical Faculty, Uludag University): 2008-4/36, 19 February 2008.
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Affiliation(s)
- Fikret Kasapoglu
- Department of Otorhinolaryngology, Uludag University, Nilufer, 16059 Bursa, Turkey.
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Ozmen OA, Ozmen S. Topical bupivacaine compared to lidocaine with epinephrine for post-tonsillectomy pain relief in children: a randomized controlled study. Int J Pediatr Otorhinolaryngol 2011; 75:77-80. [PMID: 21067823 DOI: 10.1016/j.ijporl.2010.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/27/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the topical administration of bupivacaine hydrochloride, lidocaine hydrochloride with epinephrine and saline in alleviating post tonsillectomy pain. STUDY DESIGN A double-blind prospective randomized controlled clinical study. METHODS Between November 2008 and March 2009, 60 patients (32 males and 28 females) between ages of 1.5 and 15 years were recruited into the study. After informed consent was obtained from the parents, patients, admitted for tonsillectomy, were randomized into three groups using sealed envelops. Group 1 (20 patients, mean age 5.2±1.7) received topical lidocaine hydrochloride (20 mg/ml) with 0.00125% epinephrine. Group 2 (20 patients, mean age 6±3.7) received topical 0.5% bupivacaine hydrochloride and group 3 (20 patients, mean age 6.7±3.6) received topical saline. RESULTS The post-operative pain scores at 1h were similar among the groups (p=0.29). Pain scores in bupivacaine hydrochloride group were significantly lesser than the saline group at 5th, 13th, 17th and 21st hours, until the sixth day (p<0.017). Moreover, pain scores of bupivacaine hydrochloride group were superior to lidocaine hydrochloride group starting at 17 h, until fourth day (p<0.017). Pain scores of lidocaine hydrochloride group were lesser than saline group in the first and fifth days (p<0.017), whereas, there was no significant difference at other times. CONCLUSION Topical administration of bupivacaine hydrochloride proved to provide more efficient pain control than both saline and lidocaine without any drug related complication.
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Affiliation(s)
- Omer Afşin Ozmen
- Uludağ University Medical Faculty, Department of Otorhinolaryngology, Bursa, Turkey.
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Tas E, Hanci V, Ugur MB, Turan IO, Yigit VB, Cinar F. Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation. Int J Pediatr Otorhinolaryngol 2010; 74:1171-5. [PMID: 20728227 DOI: 10.1016/j.ijporl.2010.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 07/07/2010] [Accepted: 07/09/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effects of peritonsillar injection of levobupivacaine with epinephrine in children undergoing adenotonsillectomy, through an intraindividual study. PATIENTS AND METHODS 20 children (age 6-13 years) undergoing elective tonsillectomy with or without adenoidectomy were enrolled in this prospective, randomized, intraindividual trial. After entubation and just prior to incision, 3 ml of 0.25% levobupivacaine with epinephrine was injected into one peritonsillar region while 0.9% saline was being used for the contralateral side. Amount of intraoperative blood loss, duration of tonsillectomy, postoperative pain, otalgia and hemorrhage were assessed for each side separately. Visual analog scale was used for postoperative pain assessment. Heart rate and mean arterial pressure during and after operation were also observed. The follow-up period after surgery was 10 days. RESULTS Median visual analog scale values for the levobupivacaine with epinephrine injected side was significantly lower than the saline injected side, during the first postoperative 16h (p<0.05). There were also significant differences between the intraoperative blood losses of the two sides (p<0.05). However; no significant differences were observed with respect to duration of surgery, postoperative otalgia and hemorrhage (p>0.05). CONCLUSION Preincisional injection of levobupivacaine with epinephrine decreases early postoperative pain and intraoperative blood loss as well.
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Affiliation(s)
- Ebru Tas
- Department of Otorhinolaryngology Head and Neck Surgery, Zonguldak Karaelmas University School of Medicine, Zonguldak, Turkey
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