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Preincisional Bupivacaine in Posttonsillectomy Pain Relief
A Randomized Prospective Study
Nilesh Raman Vasan, FRACS;
Scott Stevenson, FRACS;
Mark Ward, FRACS
Arch Otolaryngol Head Neck Surg. 2002;128:145-149.
Objective To determine the effect of preincisional bupivacaine hydrochloride infiltration
on postoperative pain after tonsillectomy.
Design Prospective, randomized, double-blind clinical trial.
Setting A secondary/tertiary referral center in Christchurch, New Zealand.
Patients A volunteer sample of 70 patients, aged 16 to 42 years, with recurrent
tonsillitis. Seven patients were excluded.
Interventions After randomization, one group received 5 mL of 0.5% bupivacaine hydrochloride
in the peritonsillar space, with the patient under general anesthesia. The
other group received 5 mL of isotonic sodium chloride solution, with the patient
under general anesthesia. Both groups underwent surgery with a standardized
surgical and anesthetic technique.
Main Outcome Measures Postoperative pain was assessed with a visual analog scale at 15 minutes
and 1, 4, 12, 16, and 24 hours after the procedure. Postoperative analgesic
requirement, length of admission, and antiemetic requirement were also assessed.
Results No statistical difference was found between the 2 groups for postoperative
pain by means of the visual analog scale at any time interval, nor was any
statistical difference found for the other variables measured. A trend toward
less pain in the immediate postoperative period in the group receiving bupivacaine
was noted.
Conclusion No statistically significant benefit is found for use of preincisional
bupivacaine in tonsillectomy.
From the Department of Otolaryngology–Head and Neck Surgery,
Christchurch Public Hospital, Christchurch, New Zealand (Drs Vasan, Stevenson,
and Ward); and Department of Otolaryngology–Head and Neck Surgery, Glasgow
Royal Infirmary, University NHS Trust, Glasgow, Scotland (Dr Vasan).
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Arch Otolaryngol Head Neck Surg. 2002;128(2):202-203.
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