Abstract
Objectives: To determine whether pre incisional infiltration of ropivacaine will be effective in reducing post-operative pain intensity comparable to bupivacaine.
Patient & Methods: Prospective, randomised, double blind clinical trial at Lady Hardinge Medical College, ENT Department. Sixty children, aged 5-12 years, undergoing tonsillectomy were included in the study. Patients in one of the groups received 0.375% of ropivacaine infiltration in the tonsillar fossa while the other group received 0.25% of bupivacaine infiltration 5 minutes prior to incision. Wong Baker faces pain rating scale was used to compare two groups in respect of pain control. Unpaired student t-test were used to compare the two independent groups, p< 0.005 was considered statistically significant.
Results: In the postoperative hours there was a statistically significant pain relieving effect seen in ropivacaine group (p<0.0001). in the other postoperative parameters such as nausea, fever, vomiting, bleeding, trismus, otalgia were not statistically different between two groups. There were no complications associated with ropivacaine or bupivacaine. No patients in the study suffered from any systemic side effects related to use of medication.
Conclusion: Locally infiltrating ropivacaine significantly relieves the pain of paediatric post tonsillectomy patients compared to equipotent dose of bupivacaine. Also ropivacaine is more effective to reduce postop analgesic requirement in the 1st hour and overall analgesic requirement.
Keywords: Tonsillectomy, Ropivacaine, Bupivacaine.
References
- RA McNeill. A history of tonsillectomy: two millennia of trauma, haemorrhage and Controversy. The Ulster Medical Journal, 1960.
- Mitchell RB et al. Sleep Disordered Breathing in Children: survey of current practice. Laryngoscope 2006; 116:956-8
- Schoem S.R. et al. Control of Early Postoperative Pain with Bupivacaine in Paediatric Tonsillectomy.Ear Nose Throat J. 1993; 76:560-3.
- Nalini Vedavelu et al. Recent Advances in Postoperative Pain Management. Yale J Biol 2010 March; 83(1): 11-25.
- Naja M.Z. et al. Modified infiltration technique in tonsillectomy: expanded case report of 25 children. Int J Pediatr Otorhinolaryngology (2005) 69, 35-41
- Jebeles JA et al. The effect of preincisional infiltration of tonsils with bupivacaine on the Pain following tonsillectomy under general anaesthesia, randomized control trial. Pain.1991; 47:305-8.
- Carla et al. Ropivacaine with or without clonidine improves paediatric tonsillectomy pain. Otolaryngol Head Neck Surg .2001; 127: 1265- 1270
- Park AH et al. Effect of perioperative administration of ropivacaine with epinephrine on post-operative podiatric adenotonsillectomy recovery. Prospective double blind randomized control trial. Arch Otolaryngol Head Neck Surgery 2004;130:459-64.
- Arikan OK et al. Preincisional infiltration of tonsils with ropivacaine in post tonsillectomy pain relief. Double blind randomized, placebo controlled intra individual study. J Otorhinolaryngology 2006; 35:167-72.
- Akoglu et al. ropivacaine compared to bupivacaine for post tonsillectomy pain relief in children: A randomized controlled study. Int J Pediatr Otorhinolaryngology (2006) 70, 1169-1173.
- Yusuf et al. Comparison of bupivacaine and ropivacaine on post-operative pain after tonsillectomy in paediatric patients. Int J Pediatr Otorhinolaryngology (2007) 71, 83-87.
- Arikan OK et al. High dose ropivacaine versus bupivacaine for post tonsillectomy pain. Prospective double blind randomized control trial .J Otorhinolaryngology-Head and Neck Surgery 2008;37:836-43.
- Kasapoglu F et al. Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post tonsillectomy pain relief in children: placebo control clinical study. Int J Pediatr Otorhinolaryngology 75 (2011) 322-326
- Mahmut O. et al. Comparison of ropivacaine, bupivacaine and lidocaine in the management of post tonsillectomy pain. Int J Pediatr Otorhinolaryngol. 2012 Dec; 76(12):1831-1834.
- Goodman and Gilman’s The Pharmacological Basis of Therapeutics 11th edition; 368,377.
- Goodman and Gilman’s The Pharmacological Basis of Therapeutics 11th edition; 247
- Otolaryngol Head Neck Surg. 2011; 144: S1-S30.
- Merry A.F. et al. Randomised comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children. Can J Anaesth. 2013 Dec; 60(12):1180-9
- Robinson S.R. et al. Reducing post tonsillectomy pain with cryoanalgesia: a randomised control trial. Laryngoscope 2000; 110(7): 1128-1131
- Katz J et al. pre-emptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anaesthesiology. 1992 Sep; 77(3):439-46.
- Butterworth JF 4thandStrichartz JR. Molecular mechanisms of local anaesthesia: a review, Anaesthesiology, 1990; 72:711-734.
- Mazoit JX et al. pharmacokinetics of local anaesthetics in infants and children. Clin Pharmacokinet. 2004; 43(1): 17-32.
- Tajima et al. J Clin Anesth.1997; 9:236-238.
- Alsarraf R, Sie K.2000 Otolaryngol Head Neck Surg.2000; 122:572-573.
Corresponding Author
Dr Manvi Mehta
Delhi University