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Comparison of two different local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double blind, clinical trial

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Abstract

In previous studies, it was shown that the post-tonsillectomy wound infiltration of bupivacaine can reduce postoperative pain. The objective of this study is to determine whether the postoperative wound infiltration with a mixture of bupivacaine, mepivacaine and adrenaline is more effective than the sole application of bupivacaine. A prospective, double-blind, randomized, control study included 30 patients scheduled for “cold steel” tonsillectomy. All patients obtained post-tonsillectomy infiltration of 6.25 mg bupivacaine alone on one side and 3.75 mg bupivacaine, 25 mg mepivacaine and 0.0125 mg epinephrine on the other side (intra-individual study design). Intake of analgesics and postoperative pain was assessed 0–6 days after surgery by visual analogue scale in inactivity and during swallowing by the nurse staff. Bleeding, dysphagia, pain, aspiration or extraordinary pain sensation were registered by the patient. The pain scores did not differ between the groups. All patients received systemic painkillers; 6 (20%) patients needed intravenous analgesics. Postoperative haemorrhage occurred in two patients without correlation to a certain local anaesthetic. Two patients developed sinus tachycardia for 2.5 min after epinephrine infiltration. Because of cost-effectiveness and complication rates, we recommend only post-tonsillectomy wound infiltration of bupivacaine. The injection should be placed in superficial muscle and connective tissue. A stringent systemic analgesia regime is indispensable for pain relief after tonsillectomy.

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Conflict of interest statement

None of the authors has a financial relationship to an organization mentioned in this study. For this study no sponsoring by third parties was needed.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Klaus Stelter, Joachim Hiller, John Martin Hempel, Alexander Berghaus & Martin Canis

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Dachau Medical Centre, Krankenhausstrasse 15, 85221, Dachau, Germany

    Hjalmar Hagedorn & Michaela Andratschke

Authors
  1. Klaus Stelter
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  2. Joachim Hiller
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  3. John Martin Hempel
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  4. Alexander Berghaus
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  5. Hjalmar Hagedorn
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  6. Michaela Andratschke
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  7. Martin Canis
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Correspondence to Klaus Stelter.

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Stelter, K., Hiller, J., Hempel, J.M. et al. Comparison of two different local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double blind, clinical trial. Eur Arch Otorhinolaryngol 267, 1129–1134 (2010). https://doi.org/10.1007/s00405-009-1200-8

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  • DOI: https://doi.org/10.1007/s00405-009-1200-8

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