Shanila Feroz, Zafar Mahmood, Farhan Khatri, Jawaid Alam, Maisam Abbas.
Can Post-tonsillectomy Pain be Reduced by Topical Bupivacaine? a Prospective Randomized Trial.
Pak J Otolaryngol Jan ;29(1):11-5.

INTRODUCTION: Post-operative pain and delayed oral intake can delay discharge after day-care tonsillectomy. OBJECTIVE: To assess the effectiveness of topical bupivacaine application in the tonsillar fossae for the relief of post-operative pain after tonsillectomy. STUDY DESIGN: Double blind prospective randomized trial. STUDY SETTING: Liaquat National postgraduate medical center, Karachi. SUBJECTS: 60 patients, aged 7 to 35 years, both male and female, attended otolaryngology clinic with history of recurrent tonsillitis admitted for day-care tonsillectomy. METHOD: After written informed consent from patient or parents/ guardian, patients were randomized into two groups, i.e. Group I and II both comprising 30 patients in each using sealed envelopes. Patients underwent tonsillectomy under general anesthesia according to standard procedure. At completion of procedure, Group I received bupivacaine 0.5% topical application with soaked swab tightly packed in both tonsillar fossae while Group II received topical 0.9% saline in both tonsillar fossae for 5 minutes. Main outcome measures: Postoperative pain in throat (visual analogue scale), need of analgesia, delay in start of oral food and water intake and need of readmission. RESULTS: The bupivacaine group was found to drink (p<0.001) and eat (p<0.001) earlier than the control group. The pain scores at one (p<0.001) three (p<0.001) and six (p<0.001) hours post-operatively were also found to be lower in the bupivacaine group than control group. Control group patients ask for analgesia earlier and frequently than Bupivacaine group. Duration of stay in hospital was less in bupivacaine group than control group. CONCLUSION: Topical application of 0.5% bupivacaine provides better pain relief for post- tonsillectomy and facilitates early discharge in day-care tonsillectomy as compared to control group.

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