Role of Preincisional Peritonsillar Infiltration of Bupivacaine in Postoperative Pain Relief in Tonsillectomy Patients

Abstract

Tonsillectomy is one of the most common surgical procedures carried out in ENT since ancient time, is associated with several morbidities in which the pain and bleeding being the commonest and can cause considerable delay in starting oral intake and discharge from the hospital. Different methods have been used to reduce posttonsillectomy pain including use of opioids, sucralfate and local anaesthetics. Local anaesthetics in the form of pre-incisional or post-incisional peritonsillar infiltration and also topical post-incisional spray or packing are some of the most effective methods for post-tonsillectomy pain management. In our hospital, a study was carried out for preincisional peritonsillar infiltration of 0.5% bupivacaine in tonsillectomy patients for post operative pain relief. Written informed valid consent was taken, all routine investigations were done. Pre anaesthetic check up was done and bupivacaine test dose was given, none of the patients showed allergic reactions. Our study showed that this is effective method of controlling post operative pain. Patients receiving bupivacaine showed lower pain scores 6 h post operatively. The mean pain scores for Bupivacaine group were 2.85, 5.52 and 7.04 versus 5.04, 7.04 and 7.61 in saline group at 2, 4, and 6 h post operatively (t value significant). Pre incisional peritonsillar infiltration of 0.5% bupivacaine significantly reduces postoperative pain till 6 h, thereby reducing the need of analgesics intraoperatively and post operatively. Oral intake was also earlier without any adverse effects in our study.