Ropivacaine Versus Bupivacaine in Pediatric Tonsillectomy: A Systematic Review and Meta-Analysis

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Tonsillectomy is a common pediatric surgical procedure.
• Postoperative pain management is crucial for recovery.
• Local anesthetic infiltration in the tonsillar fossa is a potential strategy for pain control.

Purpose of the Study:

• To compare the analgesic efficacy and safety of ropivacaine versus bupivacaine for local anesthetic infiltration in the tonsillar fossa during pediatric tonsillectomy.
• To evaluate postoperative pain scores, time to first analgesic requirement, and complication rates.

Main Methods:

• A systematic review and meta-analysis of eligible randomized controlled trials (RCTs) was conducted.
• Data sources included CENTRAL, PubMed, Web of Science, Scopus, and Google Scholar.
• Risk of bias was assessed using Cochrane's Risk of Bias Tool (RoB-2).
• Standardized mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CI) were used for data synthesis.

Main Results:

• Seven RCTs involving 375 pediatric patients were analyzed.
• No significant differences in pain scores were observed between ropivacaine and bupivacaine at 1, 2, 4, 6-8, and 12 hours post-tonsillectomy.
• Ropivacaine demonstrated a statistically significant superior analgesic effect at 24 hours post-surgery (SMD = -0.23, 95% CI [-0.43, -0.03]).
• Time to first analgesic requirement and complication rates were comparable between the two agents.

Conclusions:

• Ropivacaine and bupivacaine exhibit comparable clinical analgesic efficacy and safety profiles for local anesthetic infiltration in pediatric tonsillectomy.
• Ropivacaine may offer a slight advantage in pain reduction at 24 hours postoperatively.