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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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