Tonsillectomy and the value of peritonsillar infiltrations

Area of Science:

• Otolaryngology
• Anesthesiology
• Surgical Innovation

Background:

• Tonsillectomy is a common surgical procedure.
• Managing intra-operative bleeding and postoperative pain are key challenges.

Purpose of the Study:

• To evaluate the impact of peritonsillar infiltrations on bleeding and pain during elective tonsillectomy.
• To compare different infiltration solutions, including local anesthetics and saline, with a control group.

Main Methods:

• Prospective, double-blind, randomized controlled trial with 100 adult participants.
• Five groups received different peritonsillar infiltrations: bupivacaine with adrenaline, bupivacaine alone, saline with adrenaline, saline alone, or no infiltration (control).
• Intra-operative blood loss and postoperative pain scores were measured.

Main Results:

• Peritonsillar infiltrations (Groups I-IV) significantly reduced blood loss compared to the control group (47 ml vs. 121 ml, P=0.0002).
• The control group experienced the highest postoperative pain scores and required more analgesia.
• Normal saline groups (III and IV) showed the lowest pain scores at 24 hours, while bupivacaine alone (Group II) had a high incidence of nausea and vomiting (71.4%).

Conclusions:

• Peritonsillar infiltrations effectively reduce intra-operative bleeding and postoperative pain by improving the dissection plane.
• Normal saline infiltrations, with or without adrenaline, are recommended for tonsillectomy due to their efficacy, low cost, availability, and minimal side effects.
• The benefits of infiltration are independent of the specific solution, suggesting a mechanical effect rather than a pharmacological one.