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Journal of Anesthesia

, Volume 27, Issue 6, pp 844–849 | Cite as

Preoperative peritonsillar infiltration of dexamethasone and levobupivacaine reduces pediatric post-tonsillectomy pain: a double-blind prospective randomized clinical trial

  • Ahmed Sobhy BasuniEmail author
  • Hoda Alsaid Ahmed Ezz
  • Osama Amin Albirmawy
Original Article

Abstract

Background

Preoperative corticosteroids reduce post-tonsillectomy morbidities. The present study was performed to compare the effect of peritonsillar dexamethasone infiltration to intravenous injection together with peritonsillar levobupivacaine infiltration before tonsillectomy on postoperative pain in children.

Methods

One hundred twenty children, ASA I–II, aged 6–12 years, scheduled for adenotonsillectomy were enrolled in the study. They were randomized equally into two equal groups; 60 children each. Group A received peritonsillar infiltration with dexamethasone and levobupivacaine, and group B received i.v. dexamethasone and peritonsillar levobupivacaine infiltration. Rest and swallowing pain in the first postoperative day using a visual analogue scale, time to first rescue analgesia, cumulative paracetamol dose, vomiting, and adverse effects related to both interventions during the first postoperative day were recorded. Children care givers were asked to score pain using a verbal rating scale and to disclose complications as halitosis, headache, fever and otalgia during the first postoperative week.

Results

Time to first rescue analgesia was significantly longer in group A. Rest and swallowing pain in the first postoperative day, cumulative paracetamol dose, pain in the second and third postoperative days, and otalgia were significantly lower in group A. None of children developed postoperative bleeding, or complications related to dexamethasone or levobupivacaine infiltration. There was no significant difference in postoperative emesis, fever and halitosis between the groups.

Conclusion

Addition of dexamethasone to levobupivacaine for preoperative peritonsillar infiltration has better postoperative analgesic effects than i.v. dexamethasone combined with peritonsillar levobupivacaine infiltration in children.

Keywords

Post-tonsillectomy pain Local anesthetic infiltration Dexamethasone 

References

  1. 1.
    Warnock F, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain. 1998;75:37–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Robinson SR, Purdie GL. Reducing post-tonsillectomy pain with cryoanalgesia: a randomized controlled trial. Laryngoscope. 2000;110:1128–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Hollis LJ, Burton MJ, Miller JM. Perioperative local anesthesia for reducing pain following tonsillectomy. Cochrane Database Syst Rev. 1999;4:CD001874.Google Scholar
  4. 4.
    Grainger J, Saravanappa N. Local anesthetic for post-tonsillectomy pain: a systematic review and meta-analysis. Clin Otolaryngol. 2008;33:411–9.PubMedCrossRefGoogle Scholar
  5. 5.
    McLeod GA, Burke D. Levobupivacaine. Anesthesia. 2001;56:331–41.CrossRefGoogle Scholar
  6. 6.
    Karaaslan K, Yilmaz F, Gulcu N, Sarpkaya A, Colak C, Kocoglu H. The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients. Int J Pediatr Otorhinolaryngol. 2008;72:675–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Yilmaz S, Demiraran Y, Akkan N, Yaman H, Iskender A, Guclu E, Ozturk O. The effects of topical levobupivacaine on morbidity in pediatric tonsillectomy patients. Int J Pediatr Otorhinolaryngol. 2009;73:1208–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Tas E, Hanci V, Ugur MB, Turan IO, Yigit VB, Cinar F. Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation. Int J Pediatr Otorhinolaryngol. 2010;74:1171–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Fikret K, Nur KF, Gokhan T, Afsin OO, Atila K, Selcuk O. Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: placebo-controlled clinical study. Int J Pediatr Otorhinolaryngol. 2011;75:322–6.CrossRefGoogle Scholar
  10. 10.
    Steward DI, Grisel J, Meinzen-Derr J. Steroids for improving recovery following tonsillectomy in children. Coch Data Syst Rev 2011;8:CD003997.Google Scholar
  11. 11.
    Kaygusuz I, Susaman N. The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillectomy. Int J Pediatr Otorhinolaryngol. 2003;67:737–42.PubMedCrossRefGoogle Scholar
  12. 12.
    Egeli E, Akkaya S. The effect of peritonsillar corticosteroid infiltration in tonsillectomy. Auris Nasus Larynx. I997;24:179–83.Google Scholar
  13. 13.
    Montazeri k, Okhovat A, Honarmand A, Reza Safavi MR, Ashrafy L. Pre-incisional infiltration of tonsils with dexamethasone does not reduce post tonsillectomy vomiting and pain in children. Saudi J Anaesth. 2009;3:53–6.Google Scholar
  14. 14.
    Windfuhr JP. Steroids for reduction of morbidity following tonsillectomy. HNO. 2008;56(1):43–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Mohamed SK, Ibraheem AS, Adelraheem MG. Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in pediatric postoperative analgesia following tonsillectomy. Eur Otorhinolaryngeal. 2009;266:1815–9.CrossRefGoogle Scholar
  16. 16.
    Giannoni C, White S, Enneking FK, Morey T. Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Arch Otolaryngol Head Neck Surg. 2001;127:1265–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Leach J, Manning S, Schaefer S. Comparison of two methods of tonsillectomy. Laryngoscope. 1993;103:619–22.PubMedGoogle Scholar
  18. 18.
    Liu K, Hsu CC, Chia YY. Effect of dexamethasone on postoperative pain and emesis. Br J Anaesth. 1998;80:85–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48:961–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces postoperative pain and nausea after ambulatory surgery. Anesth Analg. 1998;87:913–7.Google Scholar
  21. 21.
    Stan T, Goodman E, Cardida B, Curtis RH. Adding methylprednisolone to local anesthetic increases the duration of axillary block. Reg Anesth Pain Med. 2004;29:380–1.PubMedGoogle Scholar
  22. 22.
    Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102:263–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Parrington SJ, O’Donnell D, Chan W, Brown-Shreves D, Subramanyam R, Qu M, Brull R. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Reg Anesth Pain Med. 2010;35(5):422–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol. 2006;70(1):73–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Nikandish R, Maghsoodi B, Khademi S, Motazedian S, Kaboodkhani R. Peritonsillar infiltration with bupivacaine and pethidine for relief of post-tonsillectomy pain: a randomized double-blind study. Anaesthesia. 2008;63:20–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Schoem SR, Watkins GL, Kuhn JJ, Alburger JF, Kim KZ, Thompson DH. Control of early postoperative pain with bupivacaine in adult mixture tonsillectomy. Arch Otolaryngol Head Neck Surg. 1993;119:292–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Ohlms L. Injection of local anesthetic in tonsillectomy. Arch Otolaryngol Head Neck Surg. 2001;127(10):1276–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Plante A, Turgeon AF, Zarychanski R, Lauzier F, Vigneault L, Moore L, Boutin A, Fergusson DA. Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;345:e5389.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Ahmed Sobhy Basuni
    • 1
    Email author
  • Hoda Alsaid Ahmed Ezz
    • 1
  • Osama Amin Albirmawy
    • 2
  1. 1.Department of Anesthesiology and Intensive CareFaculty of Medicine, Tanta UniversityTantaEgypt
  2. 2.Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Tanta UniversityTantaEgypt

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