EFFICACY OF INFILTRATION VERSUS SURFACE APPLICATION OF BUPIVACAINE IN REDUCING EARLY POST-TONSILLECTOMY PAIN

Abstract

Objectives: To compare the efficacy of infiltration with surface application of bupivacaine in reducing early post-tonsillectomy pain.

Materials and Methods: Prospective, interventional, single blinded, comparative study was done at Ganesh Man Singh Memorial Academy of ENT, Head and Neck Studies, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal from 1st November 2014 and 31st April 2016. Patients aged 15 or more, of both genders, who underwent tonsillectomy under general anesthesia were enrolled in the study. Following tonsillectomy, 5ml of 0.25% of bupivacaine with 1:2,00,000 adrenaline was locally infiltrated in right tonsillar bed, while on the left side, a pack soaked with the same concentration and amount of bupivacaine was placed for 5 minutes. Post- tonsillectomy pain during swallowing was assessed using Numerical rating scale and also on the basis of analgesia demanded by patient during the first two postoperative days (POD).

Results: Compared to surface application side, the mean pain score on infiltration side was lower on both 1st postoperative day (POD1) and 2nd postoperative day (POD2), however none were statistically significant (p value 0.58 on POD1 and 0.7 on POD2). Out of 23 patients who demanded intramuscular diclofenac sodium, higher number (n=18) required it on POD1. The mean pain scores for patients demanding analgesia was more on surface application side on both POD1 and POD2 although the difference was not statistically significant (p value 0.48 on POD1 and 0.08 in POD2)

Conclusion: Following tonsillectomy, surface application of 0.25% of bupivacaine with 1:2,00,000 adrenaline in tonsillar bed is equally efficacious as local infiltration in reducing early post-tonsillectomy pain.

Keywords: Bupivacaine infiltration, Numerical rating scale, Post tonsillectomy pain, Surface application, Tonsillectomy