High-dose ropivacaine versus bupivacaine for posttonsillectomy pain relief in adults

Osman Kursat Arikan, Saziye Sahin, Mustafa Kazkayasi, Nuray Bayar Muluk, Serpil Akpinar, Rahmi Kilic
Journal of Otolaryngology—Head & Neck Surgery 2008, 37 (6): 836-43

OBJECTIVE: To compare the efficacy and safety of preincisional high-dose ropivacaine with bupivacaine in relieving posttonsillectomy pain.

DESIGN: A prospective, randomized, double blind, placebo-controlled clinical trial.

SETTING: University hospital.

PATIENTS: Before the incision, 58 subjects were randomly assigned to receive 10 mL of 10 mg/mL ropivacaine hydrochloride with epinephrine (n=19, group 1), 10 mL of 2.5 mg/mL bupivacaine with epinephrine (n=20, group 2), or saline with epinephrine (n=19, group 3) as a placebo.

MAIN OUTCOMES MEASURES: Postoperative pain, additional analgesic drug consumption, otalgia, operating time, amount of intraoperative blood loss, and possible complications were assessed. The intensity of pain was scored on a visual analogue scale. The patients were followed up for 10 days after surgery.

RESULTS: There were no statistically significant differences between the demographic and operational characteristics of the patient groups. Statistically significant differences were determined between in the mean intensity of constant and swallowing pain values of group 1 and group 2 or 3, at 4, 8, and 12 hours, and on days 1, 2, 3, and 4, postoperatively. However, no statistical differences were determined between the groups on days 5, 7, and 10. A lower amount of additional analgesic drug was consumed by the ropivacaine group than by the bupivacaine group, and by the bupivacaine group than by the control group, and the differences were statistically significant.

CONCLUSION: Preincisional infiltration of the tonsils with high-dose ropivacaine markedly decreased the intensity of pain after tonsillectomy when compared with bupivacaine or placebo, especially until postoperative day 4 in adults.

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