The Effect of Local Injection of Epinephrine and Bupivacaine on Post-Tonsillectomy Pain and Bleeding

Document Type : Original

Authors

1 Cardiac Anesthesia Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Otorhinolaryngolog, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Sinus and Surgical Endoscopic Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Cardiac Anesthesia Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study. Setting: A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department.
 
Materials and Methods:
Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation. 
 
Results:
The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference.
 
Conclusion: 
Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery. 

Keywords

References

1. Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, et al. Effect of pre- vs. postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand 1996; 40(10):1210–5.               
2. Naja MZ, El-Rajab M, Kabalan W, Ziade MF, Al-Tannir MA. Pre-incisional infiltration for pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 2005; 69(10):1333–41.
3. Albaum G. The Likert scale revisited. JOURNAL-Market Research Society 1997; 39(2): 331-48.
4.  Hockenberry MJ, Wilson D. Wong’s Essentials of Pediatric Nursing. 8th ed. St. Louis: Mosby; 2009:
5. Wiatrak B, Wooley A. Pharyngitis and adenotonsillar disease. In: Cummings CH, Flint, Harker L, Editors. Cummings Otolaryngology, Head and Neck Surgery. 4th ed. Baltimore, Maryland: Mosby; 2005: 4135–65.
6. Strub KA, Tschopp K, Frei F, Kern C, Erb T. Local infiltration of epinephrine and bupivacaine before tonsillectomy. HNO 1996; 44(12):672–6.
7. Giannoni C, White S, Enneking FK, Morey T. Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Arch Otolaryngol Head Neck Surg 2001; 127(10):1265–70.
8. Sørensen WT, Wagner N, Aarup AT, Bonding P. Beneficial effect of low dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy. Auris Nasus Larynx 2003; 30(3):159–62.
9. Park AH, Pappas AL, Fluder E, Creech S, Lugo RA, Hotaling A. Effect of perioperative administration of ropivacaine with epinephrine on postoperative pediatric adenotonsillctomy recovery. Arch Otolaryngol Head Neck Surg 2004; 130(10):459–64.
10. Arikan OK, Ozcan S, Kazkayasi M, Akpinar S, Koc C. Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief. J Otolaryngol 2006; 35(3):167–72.
11. Robin J, Moodley L, Boulle R, McFadden L, Brock J. Is peri-tonsilar bupivacaine infiltration safe? (A comparison of bupivacaine with and without epinephrine). Anesthesiology 2005; 103: A1009.
12. Dhiwakar M, Clement WA, Supriya M, McKerrow WS. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database of Systematic Reviews 2005; 35(2):180–9.
13. Steward DL, Chung SJ. The role of adjuvant therapies and techniques in tonsillectomy. Current Opinion in Otolaryngology & Head and Neck Surgery 2000; 8:186–92.
Iranian Journal of Otorhinolaryngology
Volume 25, Issue 4 - Serial Number 4
September and October 2013
Pages 209-213

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