Tonsillectomy and the value of peritonsillar infiltrations

In this prospective double-blind trial, the effect of peritonsillar infiltrations was assessed with regard to intra-operative bleeding and postoperative pain in 100 young adults who underwent elective tonsillectomy under balanced general anaesthesia. Patients were randomly assigned to 1 of 5 groups (20 patients in each group) and received infiltrations as follows: group 1--bupivacaine (0.5%) with adrenaline (1:200,000); group II--bupivacaine (0.5%); group III--normal saline with adrenaline (1:200,000); group IV--normal saline; group V--no infiltration (control group). With regard to blood loss, groups I-IV lost a mean of 47 ml (95% CI = 69.78), while group V lost a mean of 121 ml (95% CI = 78.10) (P = 0.0002). Group V had the highest pain score (average 4.62) measured in recovery, 4 and 24 hours after tonsillectomy (P = 0.0051) and required more narcotic analgesia. Groups II and III had the lowest score (average 1.72) after 24 hours. The bupivacaine group (II) had the highest incidence (71.4%) of nausea and vomiting. Peritonsillar infiltrations decrease intra-operative bleeding and pain, independent of the type of solution infiltrated, by providing a better defined plane of dissection which minimises trauma to the surrounding tissue. Normal saline infiltrations with or without adrenaline should be used since they have no side-effects and are inexpensive and easily available.