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Tonsillectomy and adenoidectomy pain reduction by local bupivacaine infiltration in children
J A Jebeles1, J S Reilly, J F Gutierrez
1Division of Otolaryngology-Head and Neck Surgery, University of Alabama School of Medicine, Birmingham.
Insights
Local nerve blockade with bupivacaine significantly reduced pain after tonsillectomy and adenoidectomy in children. This anesthesia adjunct offers both short-term and long-term pain relief, improving recovery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Surgery can induce central nervous system hyperexcitability despite general anesthesia.
- Post-operative pain management in pediatric tonsillectomy and adenoidectomy is crucial for recovery.
Purpose of the Study:
- To evaluate the efficacy of pre-incisional bupivacaine infiltration in reducing pain after tonsillectomy and adenoidectomy in children.
- To compare subjective and objective pain levels between bupivacaine and saline groups.
Main Methods:
- Prospective, double-blind, placebo-controlled study.
- 22 children undergoing tonsillectomy and adenoidectomy under general anesthesia.
- Pain assessed via visual analog scale and deglutition time (100 ml) from surgery to Day 10.
Main Results:
- Bupivacaine group showed significantly lower subjective pain scores on Day 1 (16 vs. 59) and Day 5 (4 vs. 45) compared to the saline group (P < 0.05).
- Objective pain measures (deglutition time) also indicated reduced pain in the bupivacaine group.
Conclusions:
- Pre-incisional bupivacaine nerve blockade effectively reduces both short-term and long-term post-operative pain in children.
- Bupivacaine is a valuable adjunct to general anesthesia for pediatric tonsillectomy and adenoidectomy, enhancing pain control.
Abstract:
Experimental data in humans and animals suggest that during surgery, pain impulses enter the CNS creating a hyperexcitable state in spite of general anesthesia. In a prospective double blind study, pain levels in 22 children undergoing tonsillectomy and adenoidectomy under general anesthesia were compared from day of surgery to Day 10. Patients received pre-incisional infiltration with either bupivacaine (A) or saline (B). Subjective pain was assessed by visual analog scale, and objective pain by deglutition time (100 ml). Subjective constant pain was less (P < 0.05) in group (A) on Day 1: 16 (A) vs. 59 (B) and Day 5: 4 (A) vs. 45 (B). We conclude that local nerve blockade by bupivacaine reduces short- and long-term pain in children undergoing tonsillectomy and adenoidectomy in the presence of general anesthesia.