Application methods of local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double-blind, clinical trial

Klaus Stelter, John Martin Hempel, Alexander Berghaus, Michaela Andratschke, Christian W Luebbers, Hjalmar Hagedorn
European Archives of Oto-rhino-laryngology 2009, 266 (10): 1615-20
Perioperative local anaesthetics are often used to reduce the postoperative pain in tonsillectomy. There exist three different ways of applying local anaesthetics: (1) pre-incisional peritonsillar; (2) post-tonsillectomy wound infiltration; (3) post-tonsillectomy packing with soaked gauze. The objective of the study is the evaluation of differences of pain reduction comparing the three different techniques of application. The study design mainly includes intra-individual, prospective and double-blinded. One hundred and eighty patients (3-45 years) with recurrent tonsillitis were included. The charts of 156 were eligible for analysis. Bupivacaine was applied on both sides randomized in different ways. Pain on each side was registered for 6 days on the ward by a blinded nurse. When directly compared with the other two application methods, the post-tonsillectomy injection of bupivacaine provides significantly better results during the monitored time period. Postoperative bleeding was observed in 11 (7.3%) cases without any correlation to an application procedure. No other adverse effects were observed. In conclusion, post-tonsillectomy infiltration of the wounds with bupivacaine is superior to pre-incisional infiltration technique as well as post-tonsillectomy packing of the wounds with 0.5% bupivacaine-soaked gauze swab.

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