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Pre- Versus Post-Tonsillectomy Intraoperative Bupivacaine Injection in the Pediatric Population: An Age- and Surgical
Keven S Y Ji1, Nathan H Greene2, Rose J Eapen3
1Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA.
Insights
Intraoperative bupivacaine may reduce pain in young children after adenotonsillectomy but does not affect opioid use. Further research is needed to confirm its impact on pain control and opioid management in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Postoperative respiratory depression is a significant concern in children receiving opioids after adenotonsillectomy.
- Intraoperative bupivacaine administration is a potential strategy to mitigate these risks.
Purpose of the Study:
- To compare the effects of intraoperative bupivacaine on postoperative pain and sedation in pediatric patients undergoing adenotonsillectomy.
- To analyze these effects across different age and surgical indication subgroups.
Main Methods:
- A retrospective case series with chart review of 181 pediatric patients (<18 years) undergoing adenotonsillectomy.
- Comparison of outcomes between groups receiving bupivacaine before tonsil removal (pre-tonsillectomy), after tonsil removal (post-tonsillectomy), or no bupivacaine (none).
- Statistical analysis using chi-squared test and analysis of variance, with subgroup analysis by age and surgical indication.
Main Results:
- No significant differences in overall postoperative opioid doses or pain scores were observed between the groups.
- In children aged 0-5 years, pre-tonsillectomy bupivacaine was associated with the lowest discharge pain scores (p=0.004).
- In adolescents aged 12-17 years, no bupivacaine administration resulted in the lowest discharge pain scores (p=0.020).
- Bupivacaine did not improve outcomes in patients with obstructive sleep apnea or sleep-disordered breathing.
Conclusions:
- Intraoperative bupivacaine may offer pain relief benefits for younger pediatric patients undergoing adenotonsillectomy.
- The impact of bupivacaine on reducing postoperative opioid use in this population requires further investigation.
- Larger prospective studies are needed to fully elucidate the role of bupivacaine in pediatric pain management and opioid reduction.
Objectives:
Postoperative respiratory depression is of concern in children undergoing adenotonsillectomy receiving postoperative opioids and may be mitigated with intraoperative bupivacaine. This study aims to compare the impact of bupivacaine on postoperative pain and sedation in various pediatric age and surgical indication subgroups.
Methods:
This is a case series with chart review of 181 patients <18 years old undergoing adenotonsillectomy at a tertiary care center (2013-2016). Postoperative outcomes were compared between those who received intraoperative bupivacaine before (pre-tonsillectomy) or after (post-tonsillectomy) tonsil removal and those who did not (none) using χ2 test and analysis of variance. Subanalysis was performed after stratifying into age and surgical indication subgroups.
Results:
Ninety-eight patients were included in the pre-tonsillectomy group, 47 in the post-tonsillectomy group, and 36 in the none group. The number of postanesthesia care unit opioid doses (P = .159) and pain scores at arrival (P = .362) or discharge (P = .255) were not significantly different between treatment groups overall. Among 0- to 5-year-olds, pre-tonsillectomy injection was associated with lowest mean (SD) discharge pain score of 0.55 (1.29) pre-tonsillectomy versus 0.71 (1.37) post-tonsillectomy versus 2 (1.63) none group (P = .004). Among 12- to 17-year-olds, no injection was associated with lowest mean (SD) discharge pain score of 2.33 (0.52) pre-tonsillectomy versus 5 (2.65) post-tonsillectomy versus 1.63 (1.60) none group (P = .020). Injection in patients with obstructive sleep apnea and/or sleep-disordered breathing did not improve postoperative outcomes.
Conclusion:
Intraoperative bupivacaine may improve pain scores in younger pediatric populations, though it may not impact the amount of postoperative opioid use. Prospective analysis with a larger sample size is warranted to better outline opioid usage and pain control in this group.
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