Efficacy of differential dose of topical bupivacaine for post-operative pain management in paediatric ambulatory tonsillectomy: A prospective randomized study

Abstract

Introduction: Tonsillectomy is one of the most commonly performed procedures in Otolaryngology. Poor postoperative pain management may result in unplanned admission. Topical application of bupivacaine has been shown to be safe with rare or no complications. This study aims to compare topical application of 0.5% bupivacaine and 0.25% Bupivacaine for post tonsillectomy pain management.

Material and methods: This was a prospective randomized, double blind study of sixty patients ASA I and II patients aged between 5 to 12 years scheduled for ambulatory tonsillectomy. Anaesthesia was standardized for all patients. Patients were randomized into two groups A and B. After haemostasis was achieved, group A and B received 5mls of 0.5% and 0.25% soaked in a gauze on both sides of their tonsillar fossae tightly packed for 5 minutes. Pain intensity, Time to first analgesic dose and oral intake and cumulative dose of paracetamol before discharge was recorded.

Results: There was significant reduction in pain intensity more among patients group A 1.46(±1.17) & 2.80(±0.81) compared to group B 3.16(±1.38) & 3.02(±1.62). Time to first analgesic request (TFA) was longer in group A 8.84 (3.24) hours, when compared to group B which had a mean duration of 6.72(1.56) hours, with a p-value of 0.036. The cumulative dose of paracetamol consumption (CDP) was also lower among patients who had 0.5% bupivacaine compared to 0.25% bupivacaine p-value = 0.018

Conclusion: This study demonstrated topical 0.5% Bupivacaine provided superior post-operative analgesia, early resumption to oral intake than topical application of 0.25% Bupivacaine without any side effect