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Control of early postoperative pain with bupivacaine in pediatric tonsillectomy
S R Schoem1, G L Watkins, J J Kuhn
1Department of Otolaryngology-Head and Neck Surgery, National Naval Medical Center, Bethesda, MD 20889-5000.
Insights
Intraoperative bupivacaine hydrochloride did not significantly improve early pain control or oral intake in pediatric tonsillectomy patients. This study found bupivacaine safe but not superior to saline for tonsillectomy pain management.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Post-tonsillectomy pain is a significant issue in pediatric recovery.
- Current pain management strategies are often inadequate, impacting oral intake and hospital stays.
- Intraoperative bupivacaine hydrochloride is anecdotally suggested for prolonged pain relief.
Purpose of the Study:
- To evaluate the efficacy of intraoperative bupivacaine hydrochloride infiltration for early postoperative pain control in pediatric tonsillectomy.
- To assess the impact of bupivacaine on oral intake and analgesic requirements.
- To determine if bupivacaine offers an advantage over saline in managing pain after pediatric tonsillectomy.
Main Methods:
- A prospective, randomized, double-blinded study was conducted on 50 pediatric patients (ages 3-16).
- Patients received either 0.5% bupivacaine or saline injected into each tonsillar fossa post-resection.
- Parental reports on pain levels, oral intake, and acetaminophen use were collected at 2, 6, and 10 hours postoperatively.
Main Results:
- Bupivacaine hydrochloride was found to be safe, with no adverse effects reported.
- No statistically significant differences in perceived pain levels were observed between the bupivacaine and saline groups at 2, 6, or 10 hours.
- Oral intake levels and the number of acetaminophen doses administered were similar between the two groups, although bupivacaine patients required fewer doses.
Conclusions:
- Intraoperative bupivacaine hydrochloride infiltration is safe for pediatric tonsillectomy.
- Bupivacaine does not offer a significant advantage over saline in controlling early postoperative pain or improving oral intake.
- Further research may be needed to explore alternative or adjunct pain management strategies for pediatric tonsillectomy.
Abstract:
Early postoperative pain following pediatric tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and occasionally requires overnight hospitalization in same day surgery practices. Several otolaryngologists anecdotally support intraoperative infiltration with a long-acting amide anesthetic, bupivacaine hydrochloride, for postoperative pain control. However, no previous study supports these claims. At the National Naval Medical Center, a prospective, randomized, double-blinded study was undertaken in fifty patients, ages 3 to 16 years old. After tonsil resection, either 0.5% bupivacaine or saline was injected into each fossa. We asked the parents three questions. First, what was the level of pain at 2, 6 and 10 hours postoperatively? Second, what was the amount of oral intake during the first 10 hours after surgery? And third, how many doses of oral acetaminophen elixir were administered over the first 10 postoperative hours? Bupivacaine administration caused no adverse effects. There was no difference in perceived pain level between bupivacaine and saline groups at 2, 6 and 10 hours. Oral intake levels over the first 10 hours were similar. Although bupivacaine group patients received fewer doses of oral acetaminophen, the difference between groups was not statistically significant. We conclude that bupivacaine is a safe medication for infiltration, but offers no advantage over saline in the control of early postoperative pain in pediatric tonsillectomy.