Preincisional infiltration with bupivacaine in tonsillectomy

To investigate the value of preincisional peritonsillar infiltration of bupivacaine hydrochloride before tonsillectomy under general anesthesia.

Double-blind trial with two groups comparing 0.25% bupivacaine with placebo (normal saline). The patients were followed up for 10 days after surgery.

Department of Otolaryngology, University Hospital of Aarhus (Denmark).

Men and women 18 to 40 years of age referred to our department for bilateral tonsillectomy, but with no sign of acute infection or suspected malignant neoplasm. Twenty-six patients entered the study; five were excluded for failure to complete the postoperative data; and two, one from each group, had postoperative bleeding. Data from 19 patients were analyzed, nine in the bupivacaine group and 10 in the placebo group.

One group had 5 mL of 0.25% bupivacaine hydrochloride (Marcaine) infiltrated around each tonsil, the other an identical placebo (normal saline) infiltration.

A visual analogue scale was used as the primary efficacy measure. The daily intake of analgesics and a possible weight loss were registered.

A notably lower score on the visual analogue scale was found in the bupivacaine group.

Preoperative blocking of nociceptive impulses reduces prolonged postoperative pain, but no reduction in the intake of analgesics was found. Medication was insufficient for the first postoperative days.