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Peritonsillar infiltration with bupivacaine for paediatric tonsillectomy
J C Stuart1, F B MacGregor, C S Cairns
1Department of Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow.
Insights
Peritonsillar infiltration with bupivacaine provided short-term pain relief for children undergoing adenotonsillectomy. Pain scores were lower upon awakening and at 10 minutes but not significantly different later.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Adenotonsillectomy is a common pediatric surgical procedure.
- Effective postoperative pain management is crucial for pediatric recovery.
- Peritonsillar infiltration is a potential analgesic technique.
Purpose of the Study:
- To evaluate the efficacy of peritonsillar bupivacaine infiltration for analgesia in children undergoing adenotonsillectomy.
Main Methods:
- Double-blind, randomized study involving 42 children.
- Comparison of 0.25% plain bupivacaine versus saline for peritonsillar infiltration.
- Pain scores assessed post-anesthesia at multiple time points (awakening, 10 min, 1, 4, 24 hours).
Main Results:
- Significantly lower pain scores in the bupivacaine group upon awakening and at 10 minutes post-procedure (P < 0.05).
- No significant difference in pain scores between groups at 1 hour, 4 hours, or 24 hours.
- Moderate effectiveness observed for bupivacaine analgesia.
Conclusions:
- Peritonsillar bupivacaine infiltration offers limited, short-term postoperative pain relief for pediatric adenotonsillectomy.
- Further research may explore adjuncts or alternative analgesic strategies for sustained pain control.
Abstract:
In a double-blind study forty-two children scheduled for elective adenotonsillectomy were randomized to receive peritonsillar infiltration, following induction of anaesthesia, with either 0.25% plain bupivacaine or 0.9% saline, 0.5 ml/kg to a maximum of 10 ml. The children were assessed on awakening, and then 10 minutes, 1 hour, 4 hours and 24 hours later. On each occasion the observer gave the child a pain score from 1 (no pain) to 5 (severe pain). The scores on awakening and after 10 minutes were significantly lower in the bupivacaine group (P < 0.05, Mann-Whitney U test). Thereafter there was no difference between the groups. The authors conclude that peritonsillar infiltration with bupivacaine is only moderately useful as analgesia for children having tonsillectomy.