Preincisional infiltration with bupivacaine in tonsillectomy

OBJECTIVE: To investigate the value of preincisional peritonsillar infiltration of bupivacaine hydrochloride before tonsillectomy under general anesthesia.

DESIGN: Double-blind trial with two groups comparing 0.25% bupivacaine with placebo (normal saline). The patients were followed up for 10 days after surgery.

SETTING: Department of Otolaryngology, University Hospital of Aarhus (Denmark).

PATIENTS: Men and women 18 to 40 years of age referred to our department for bilateral tonsillectomy, but with no sign of acute infection or suspected malignant neoplasm. Twenty-six patients entered the study; five were excluded for failure to complete the postoperative data; and two, one from each group, had postoperative bleeding. Data from 19 patients were analyzed, nine in the bupivacaine group and 10 in the placebo group.

INTERVENTION: One group had 5 mL of 0.25% bupivacaine hydrochloride (Marcaine) infiltrated around each tonsil, the other an identical placebo (normal saline) infiltration.

OUTCOME MEASURES: A visual analogue scale was used as the primary efficacy measure. The daily intake of analgesics and a possible weight loss were registered.

RESULTS: A notably lower score on the visual analogue scale was found in the bupivacaine group.

CONCLUSIONS: Preoperative blocking of nociceptive impulses reduces prolonged postoperative pain, but no reduction in the intake of analgesics was found. Medication was insufficient for the first postoperative days.