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Vocal cord paralysis as a consequence of peritonsillar infiltration with bupivacaine
N Weksler1, M Nash, V Rozentsveig
1Division of Anesthesiology and Intensive Care, Soroka University Medical Center, Faculty of the Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. weksler@bgumail.bgu.ac.il
Insights
Peritonsillar bupivacaine infiltration for pediatric tonsillectomy pain relief can rarely cause vocal cord paralysis. This case highlights a rare complication requiring reintubation, emphasizing the need for awareness among medical professionals.
Area of Science:
- Anesthesiology
- Otolaryngology
- Pediatric Surgery
Background:
- Postoperative pain management is crucial for pediatric tonsillectomy patients.
- Peritonsillar bupivacaine infiltration is a common method for pain control in tonsil surgery.
- Children often resist traditional pain medication routes like intramuscular or rectal administration.
Observation:
- A 5-year-old girl received preoperative peritonsillar bupivacaine infiltration for tonsillectomy.
- Following surgery and extubation, the patient developed stridor and respiratory distress.
- Laryngoscopy revealed bilateral vocal cord paralysis.
Findings:
- The patient required reintubation due to respiratory distress caused by vocal cord paralysis.
- The complication resolved within five hours, with successful extubation.
- Bilateral vocal cord paralysis is an uncommon but serious complication of peritonsillar bupivacaine infiltration.
Implications:
- Anesthesiologists and surgeons must be aware of the potential for vocal cord paralysis after peritonsillar bupivacaine infiltration.
- This case underscores the importance of careful patient monitoring following tonsillectomy.
- Alternative pain management strategies or cautious application of local anesthetics may be considered.
Abstract:
Reduction of postoperative pain is an important goal in the perioperative management of tonsillectomy patients. This is particularly the case for children, who often exhibit resistance to intramuscular or rectal administration of drugs. Peritonsillar bupivacaine infiltration, a relatively safe method of pain control, is in some centers frequently used by otolaryngologists for pain relief. We present the case of a 5-year-old girl who developed bilateral vocal cord paralysis following preoperative peritonsillar bupivacaine infiltration. After an uneventful tonsillectomy and extubation, stridor and respiratory distress developed. Bilateral vocal cord paralysis was seen on laryngoscopy. The patient was reintubated and five hours later was successfully extubated without further sequelae. Anesthesiologists and surgeons should be aware of this uncommon complication than can occur with the use of peritonsillar bupivacaine infiltration for pain control in tonsil surgery.