Department of Anesthesiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Eur Arch Otorhinolaryngol. 2022 May;279(5):2599-2602. doi: 10.1007/s00405-021-07049-0. Epub 2021 Sep 14.
In this study we aimed to compare the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children.
In this randomized double-blind clinical trial study 60 children with ASA = I-II aged 5-12 years undergoing tonsillectomy were involved. The first group received bupivacaine at a dose of 0.1 mg/kg that was injected into the bed and the anterior crease of each tonsil. The second group was given intravenous acetaminophen at a dose of 12.5 mg/kg. The patient's pain score at 10, 30, 60 min after his/her admission to recovery room and 120, 240 and 360 min after the surgery was recorded using CHEOPS. Patient's sedation score, nausea or vomiting, the time of the first request for analgesia and the time of starting oral feeding were recorded and analyzed too.
There was no significant differences in mean age (p value = 0.44), gender (p value = 0.79), weight (p value = 0.36), height (p value = 0.17), anesthesia duration (p.value = 0.85) and surgery duration (p.value = 0.73) between two groups. Postoperative pain was significantly less in the bupivacaine group at 240 and 360 min after the surgery. The mean sedation score was higher in the bupivacaine group but not significantly. There was no significant difference between groups regarding the nausea and vomiting, the first analgesics request time and the start time of oral feeding.
According to the results of the present study, since administration of peritonsillar bupivacaine compared to acetaminophen had a better effect on managing postoperative pain and improving sedation and also since no complications were reported; therefore, peritonsillar infiltration with bupivacaine is suggested for pediatric tonsillectomy.
本研究旨在比较扁桃体周围注射布比卡因和静脉注射对乙酰氨基酚在儿童扁桃体切除术后疼痛的疗效。
本随机双盲临床试验研究纳入了 60 名 ASA = I-II 级、年龄在 5-12 岁的行扁桃体切除术的儿童。第一组给予 0.1mg/kg 的布比卡因注射到每个扁桃体的床和前皱襞。第二组给予 12.5mg/kg 的静脉注射对乙酰氨基酚。患者在进入恢复室后 10、30、60 分钟以及手术后 120、240 和 360 分钟时，采用 CHEOPS 记录疼痛评分。记录并分析患者的镇静评分、恶心或呕吐、首次要求镇痛的时间以及开始口服喂养的时间。
两组间的平均年龄（p 值=0.44）、性别（p 值=0.79）、体重（p 值=0.36）、身高（p 值=0.17）、麻醉时间（p 值=0.85）和手术时间（p 值=0.73）均无显著差异。在手术后 240 和 360 分钟时，布比卡因组的术后疼痛明显减轻。布比卡因组的平均镇静评分较高，但无显著差异。两组间恶心呕吐、首次要求镇痛的时间和开始口服喂养的时间无显著差异。
根据本研究结果，由于扁桃体周围注射布比卡因与对乙酰氨基酚相比，在管理术后疼痛和改善镇静方面效果更好，且无并发症报告，因此建议在儿童扁桃体切除术中行扁桃体周围浸润布比卡因。
