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Comparison of preoperative with postoperative topical lidocaine spray on pain after tonsillectomy
1Department of Anaesthesia, Faculty of Medicine, Ain-Shams and Zagazig University, Egypt.
Insights
Topical lidocaine spray reduced postoperative pain in children undergoing tonsillectomy. While effective for short-term pain relief, pre-emptive analgesia was not supported by these findings.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Postoperative pain management is crucial for recovery after tonsillectomy.
Purpose of the Study:
- To evaluate the efficacy of topical tonsillar lidocaine spray for postoperative pain management in children undergoing tonsillectomy.
- To compare pre-operative versus post-operative application of topical lidocaine.
- To assess the impact on analgesic consumption and recovery.
Main Methods:
- Randomized controlled trial involving 75 children aged 4-6 years.
- Three groups: pre-operative topical lidocaine spray, post-operative topical lidocaine spray, and control (no spray).
- Pain scores, paracetamol consumption, and need for additional analgesics (pethidine) were recorded.
Main Results:
- Topical lidocaine significantly reduced postoperative pain at 0.5 and 1 hour after waking compared to the control group.
- Lidocaine groups showed decreased paracetamol consumption and no need for pethidine.
- No significant difference in pain scores between pre- and post-operative lidocaine groups, though pre-operative use trended towards faster wakefulness.
Conclusions:
- Topical lidocaine provides short-acting analgesia for tonsillectomy pain in children.
- The study does not support the theory of pre-emptive analgesia with topical lidocaine.
- Topical lidocaine can be a useful adjunct for managing immediate postoperative pain.
Abstract:
Seventy-five children aged 4-6 years scheduled for tonsillectomy were randomly allocated to receive either topical tonsillar spray with 10% lidocaine 4 mg kg-1 3 minutes before surgical incision; identical tonsillar spray after both tonsils had been removed; or no topical spray (control group). There were significant differences in postoperative pain between the lidocaine groups and the control group at 0.5 and one hour after awaking (P < 0.05). Also in the lidocaine groups, consumption of paracetamol on the day of operation was less, and additional postoperative pethidine was not required. There were no significant differences between pre- and postoperative lidocaine groups in pain scores during the observation period but the use of pre-operative lidocaine tended to be associated with a more rapid return to calm wakefulness. Topical lidocaine seemed to have short-acting analgesic activity. The results of this study do not support the theory of pre-emptive analgesia.