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Ropivacaine With or Without Clonidine Improves Pediatric Tonsillectomy Pain
Carla Giannoni, MD;
Sno White, MD;
F. Kayser Enneking, MD;
Timothy Morey, MD
Arch Otolaryngol Head Neck Surg. 2001;127:1265-1270.
Objective To determine if preemptive analgesia with ropivacaine hydrochloride
with or without clonidine hydrochloride decreases pain and hastens recovery
after tonsillectomy.
Design Prospective, randomized, triple-blinded trial.
Setting University referral center; pediatric ambulatory practice.
Participants Sixty-four children, aged 3 to 15 years, undergoing tonsillectomy.
Interventions Patients received injections in the tonsillar fossae of isotonic sodium
chloride, ropivacaine, or ropivacaine plus clonidine prior to tonsil excision.
Main Outcome Measures Visual analogue (pain) scale scores at rest and when drinking, opioid
use, recovery time to normal activity, and incidence of symptoms such as otalgia.
Results Pain was reduced on postoperative day 0 in the ropivacaine-treated and
ropivacaine plus clonidine–treated groups as compared with the isotonic
sodium chloride–treated group (P<.05). Pain
was also decreased in the ropivacaine plus clonidine–treated group on
postoperative days 3 and 5 (P<.05). Intravenous
narcotic use was decreased on day 0 in the ropivacaine-treated and ropivacaine
plus clonidine–treated groups (P<.05). Cumulative
codeine use was similar at day 3 for all patients, but was decreased at day
5 in the ropivacaine plus clonidine–treated group (P<.05). The incidence of otalgia decreased from 89% (16/18) in the
isotonic sodium chloride–treated group to 63% (12/19) in the ropivacaine-treated
and 61%(11/18) in the ropivacaine plus clonidine–treated groups (P<.01). Recovery to normal activity was shortened from
8.1 ± 1.6 days to 5.8 ± 2.9 days (mean ± SD) in the isotonic
sodium chloride–treated and ropivacaine plus clonidine–treated
groups, respectively (P = .03).
Conclusion Preincisional injection of ropivacaine with clonidine prior to tonsillectomy
has a preemptive analgesic effect that outlasts the local anesthetic and decreases
pain, opioid use, and the time to return to normal activity.
From the Department of Otorhinolaryngology, Baylor College of Medicine,
Houston, Tex (Dr Giannoni); and the Department of Anesthesia, University of
Florida, Gainesville (Drs White, Enneking, and Morey). Dr Giannoni is now
with the Texas Children's Hospital, Houston. Drs White and Enneking are members
of the Speakers' Bureau for AstraZeneca US, Westboro, Mass.
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