Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-01-2020 | Tonsillectomy | Head and Neck

Comparing local anesthetic infiltration of the peritonsillar region and glossotonsillar sulcus for post-tonsillectomy pain management

Authors: Nur Yücel Ekici, Hatice Özdoğan

Published in: European Archives of Oto-Rhino-Laryngology | Issue 1/2020

Abstract

Purpose

The objective of this study was to compare the efficacy of peritonsillar and glossotonsillar sulcus infiltration with bupivacaine to manage postoperative pain and odynophagia in children undergoing tonsillectomy.

Methods

Fifty children (5–10 years of age) undergoing tonsillectomy due to recurrent tonsillar infections were enrolled in the study and assigned into two groups receiving either pre-incisional peritonsillar (Group 1, n = 25) or glossotonsillar sulcus (Group 2, n = 25) infiltration with 1 mg/kg bupivacaine (0.5%) totaling 5 mL in volume. At different time intervals following arrival to the post-anesthesia care unit (PACU), the participants in each group were evaluated for pain using the modified Children’s Hospital of Eastern Ontario Pain Scale (mCHEOPS) and for odynophagia using a four-point scale (1—none, normal or no difficulty with swallowing, 2—mild, mild difficulty with swallowing, 3—moderate, moderate difficulty with swallowing, and 4—severe, no swallowing or swallowing only with maximal effort). Additional parameters were assessed for 24 h post-surgery, including time to first administration of analgesic, additional analgesic requirements, nausea/vomiting, allergic reaction, and bleeding.

Results

Infiltration of either region with bupivacaine yielded similar analgesic effects at different times following the surgery (P = 0.065). Time to first analgesic treatment and additional analgesic requirements were not significantly different between groups (P = 0.181). Compared to the Group 1, Group 2 was associated with significantly lower odynophagia scores at different times after the surgery (P = 0.020).

Conclusion

Present results indicate that the infiltration of local anesthetics to glossotonsillar sulcus is a safe, practical, and effective pain management intervention without risk of significant side effects for children undergoing tonsillectomy.

Kasapoglu F, Kaya FN, Tuzemen G, Ozmen OA, Kaya A, Onart S (2011) Comparison of peritonsillarlevobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: placebo-controlled clinical study. Int J Pediatr Otorhinolaryngol 75:322–326. https://doi.org/10.1016/j.ijporl.2010.11.015 CrossRefPubMed

Sun J, Wu X, Meng Y, Jin L (2010) Bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children: a meta-analysis. Int J PediatrOtorhinolaryngol 74:369–373. https://doi.org/10.1016/j.ijporl.2010.01.004 CrossRef

Wang C, Kundaria S, Fernandez-Miranda J, Duvvuri U (2016) A description of the anatomy of the glossopharyngeal nerve as encountered in transoral surgery. Laryngoscope 126:2010–2015. https://doi.org/10.1002/lary.25706 CrossRefPubMed

Lim CM, Mehta V, Chai R, Pinheiro CN, Rath T, Snyderman C, Duvvuri U (2013) Transoral anatomy of the tonsillar fossa and lateral pharyngeal wall: anatomic dissection with radiographic and clinical correlation. Laryngoscope 123:3021–3025. https://doi.org/10.1002/lary.23927 CrossRefPubMed

Stelter K, Hempel JM, Berghaus A, Andratschke M, Luebbers CW, Hagedorn H (2009) Application methods of local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double-blind, clinical trial. Eur Arch Otorhinolaryngol 266:1615–1620. https://doi.org/10.1007/s00405-008-0909-0 CrossRefPubMed

Mohamed SK, Ibraheem AS, Abdelraheem MG (2009) Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in pediatric postoperative analgesia following tonsillectomy. Eur Arch Otorhinolaryngol 266:1815–1819. https://doi.org/10.1007/s00405-009-0937-4 CrossRefPubMed

Vlok R, Melhuish TM, Chong C, Ryan T, White LD (2017) Adjuncts to local anaesthetics in tonsillectomy: a systematic review and meta-analysis. J Anesth 31:608–616. https://doi.org/10.1007/s00540-017-2310-x CrossRefPubMed

Ju NY, Cui GX, Gao W (2013) Ropivacaine plus dexamethasone infiltration reduces postoperative pain after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 77:1881–1885. https://doi.org/10.1016/j.ijporl.2013.08.037 CrossRefPubMed

Karaaslan K, Yilmaz F, Gulcu N, Sarpkaya A, Colak C, Kocoglu H (2008) The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients. Int J Pediatr Otorhinolaryngol 72:675–681. https://doi.org/10.1016/j.ijporl.2008.01.029 CrossRefPubMed

10.

Paradise JL, Bluestone CD, Bachman RZ et al (1984) Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med 310:674–683. https://doi.org/10.1056/NEJM198403153101102 CrossRefPubMed

11.

Yenigun A, Et T, Aytac S, Olcay B (2015) Comparison of different administration of ketamine and intravenous tramadol hydrochloride for postoperative pain relief and sedation after pediatric tonsillectomy. J Craniofac Surg 26:21–24. https://doi.org/10.1097/SCS.0000000000001250 CrossRef

12.

Tong Y, Ding XB, Wang X, Ren H, Chen ZX, Li Q (2014) Ketamine peritonsillar infiltration during tonsillectomy in pediatric patients: an updated meta-analysis. Int J Pediatr Otorhinolaryngol 78:1735–1741. https://doi.org/10.1016/j.ijporl.2014.07.036 CrossRefPubMed

13.

Unal Y, Pampal K, Korkmaz S, Arslan M, Zengin A, Kurtipek O (2007) Comparison of bupivacaine and ropivacaine on postoperative pain after tonsillectomy in paediatric patients. Int J Pediatr Otorhinolaryngol 71:83–87. https://doi.org/10.1016/j.ijporl.2006.09.005 CrossRefPubMed

14.

Maryam H, Amin J, Sedighe V, Vida A (2017) Comparing the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain. Eur Arch Otorhinolaryngol 274:2521–2527. https://doi.org/10.1007/s00405-017-4477-z CrossRefPubMed

15.

Grainger J, Saravanappa N (2008) Local anaesthetic for post-tonsillectomy pain: a systematic review and meta-analysis. Clin Otolaryngol 33:411–419. https://doi.org/10.1111/j.1749-4486.2008.01815.x CrossRefPubMed

16.

Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, Auboyer C (1996) Effect of pre- vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand 40:1210–1215. https://doi.org/10.1111/j.1399-6576.1996.tb05552.x CrossRefPubMed

17.

Park HP, Hwang JW, Park SH, Jeon YT, Bahk JH, Oh YS (2007) The effects of glossopharyngeal nerve block on postoperative pain relief after tonsillectomy: the importance of the extent of obtunded gag reflex as a clinical indicator. Anesth Analg 105:267–271. https://doi.org/10.1213/01.ane.0000266440.62424.f1 CrossRefPubMed

18.

Dahi-Taleghani M, Mousavifard S, Tahmoureszade S, Dabbagh A (2011) Rectal acetaminophen versus peritonsillar infiltration of bupivacaine for postoperative analgesia after adenotonsillectomy in children. Eur Arch Otorhinolaryngol 268:581–584. https://doi.org/10.1007/s00405-010-1434-5 CrossRefPubMed

19.

Nikandish R, Maghsoodi B, Khademi S, Motazedian S, Kaboodkhani R (2008) Peritonsillar infiltration with bupivacaine and pethidine for relief of post-tonsillectomy pain: a randomised double-blind study. Anaesthesia 63:20–25. https://doi.org/10.1111/j.1365-2044.2007.05283.x CrossRefPubMed

20.

Weksler N, Nash M, Rozentsveig V, Schwartz JA, Schily M, Gurman GM (2001) Vocal cord paralysis as a consequence of peritonsillar infiltration with bupivacaine. Acta AnaesthesiolScand 45:1042–1044. https://doi.org/10.1034/j.1399-6576.2001.450820.x CrossRef

21.

Shlizerman L, Ashkenazi D (2005) Peripheral facial nerve paralysis after peritonsillar infiltration of bupivacaine: a case report. Am J Otolaryngol 26:406–407. https://doi.org/10.1016/j.amjoto.2005.02.019 CrossRefPubMed

Title: Comparing local anesthetic infiltration of the peritonsillar region and glossotonsillar sulcus for post-tonsillectomy pain management
Authors: Nur Yücel Ekici
Hatice Özdoğan
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Tonsillectomy
Analgesics in Dentistry
Anesthetics
Anesthetics
Published in: European Archives of Oto-Rhino-Laryngology / Issue 1/2020
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-019-05668-2

At a glance: The STEP trials

Springer Medicine

Comparing local anesthetic infiltration of the peritonsillar region and glossotonsillar sulcus for post-tonsillectomy pain management

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

The relationship between the findings of vestibular evoked myogenic potentials and severity of obstructive sleep apnea syndrome

Value of pre- and intraoperative diagnostic methods in suspected glottic neoplasia

An improved method for examining fat taste

Endoscopic stapedotomy: safety and audiological results in 150 patients

Prediction of aspiration in dysphagia using logistic regression: oral intake and self-evaluation

Quantitative criteria for age-related hearing loss using audiometric configuration analysis