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

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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.

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Acknowledgements

We would like to thank our colleagues and the nursing staff at Adana City Training and Research Hospital, Adana, Turkey, for their cooperation and timely help.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Adana City Training and Research Hospital, 01060, Adana, Turkey

    Nur Yücel Ekici

  2. Department of Anesthesiology and Reanimation, Adana City Training and Research Hospital, Adana, Turkey

    Hatice Özdoğan

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  1. Nur Yücel Ekici
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Correspondence to Nur Yücel Ekici.

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The authors declare that they have no competing interest.

Ethical approval

The study was conducted and completed in accordance with the ethical principles outlined in the Declaration of Helsinki and was approved by the Ethics Committee of Adana City Training and Research Hospital in Adana, Turkey (19-KAEK-382). Written informed consent was obtained from the parent or legal guardian of each participant following a detailed explanation of the study protocol and risks and benefits of participation.

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Yücel Ekici, N., Özdoğan, H. Comparing local anesthetic infiltration of the peritonsillar region and glossotonsillar sulcus for post-tonsillectomy pain management. Eur Arch Otorhinolaryngol 277, 255–260 (2020). https://doi.org/10.1007/s00405-019-05668-2

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  • DOI: https://doi.org/10.1007/s00405-019-05668-2

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