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Albert H. Park, MD; Ana Lucia Pappas, MD; Elaine Fluder, MSN, RN; Steve Creech, MS; Ralph A. Lugo, PharmD; Andrew Hotaling, MD

Arch Otolaryngol Head Neck Surg. 2004;130:459-464.

Objectives  To determine whether perioperative administration of ropivacaine hydrochloride with epinephrine decreases postoperative pain following adenotonsillectomy and to determine the pharmacokinetics of ropivacaine following injection.

Design  Prospective, randomized, double-blind clinical trial.

Setting  University pediatric ambulatory center.

Participants  A total of 130 children, aged 2 to 12 years, undergoing adenotonsillectomy.

Intervention  Patients received injections, in the tonsillar fossae, of isotonic sodium chloride solution or 0.5% ropivacaine hydrochloride with epinephrine immediately following tonsillectomy.

Main Outcome Measures  Modified objective pain score, time to 100 mL of oral intake, serial plasma ropivacaine levels, use of analgesics, incidence of retching and emesis, and other symptoms.

Results  Fifty-three patients (80%) in the ropivacaine group had detectable plasma levels in at least 3 of the 4 measurement time periods. The mean ± SD peak concentration (C_max) was 0.71 ± 0.33 µg/mL and the half-life was 0.96 hours. The average modified objective pain scores over all time points favored the placebo group (P = .06 test of between-subjects effects). Similarly, the average behavior score over time favored the placebo group (P = .046 test of between-subjects effects). Neck pain was better in the placebo group when averaged over postoperative days 1, 3, 7, and 14 (P = .04). The percentage of patients who had retching in the recovery room was greater in the ropivacaine group (41% vs 19%, P = .006).

Conclusions  The injection of 0.5% ropivacaine with epinephrine immediately following adenotonsillectomy results in a measurable plasma level. Ropivacaine with epinephrine injection does not reduce pain postoperatively and adversely affects behavior scores, neck pain scores, and retching frequency compared with placebo. Ropivacaine with epinephrine injection for postoperative analgesia is not recommended for this patient population.

From the Departments of Surgery (Dr Park), Pediatrics (Drs Park and Lugo), and Pharmacy Practice (Dr Lugo), University of Utah, Salt Lake City; Departments of Anesthesiology (Dr Pappas and Ms Fluder) and Otolaryngology (Dr Hotaling), and Oncology Institute (Mr Creech), Loyola University Medical Center, Maywood, Ill. The authors have no relevant financial interest in this article.

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