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

Ebraheem Albazee1,2, Khaled Alenezi3, Abdulwahab Alkandari3

  • 1Otorhinolaryngology-Head and Neck Surgery Kuwait Institute for Medical Specializations (KIMS) Kuwait City Kuwait.

OTO Open
|September 22, 2025
PubMed

Insights

Ropivacaine and bupivacaine provide similar pain relief after tonsillectomy in children. Ropivacaine showed a slight advantage in reducing pain at 24 hours post-surgery, with comparable safety profiles.

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.
Abstract

Keywords:
analgesiabupivacainepainropivacainetonsillectomy

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