Preoperative anesthetic infiltration does not reduce posttonsillectomy pain

By David Douglas

NEW YORK (Reuters Health) – Pre-incisional infiltration of bupivacaine hydrochloride has no significant effect on pain relief following tonsillectomy under general anesthesia, researchers report in the February issue of the Archives of Otolaryngology–Head and Neck Surgery.

Dr. Nilesh Raman Vasan, of Glasgow Royal Infirmary, UK, and colleagues in New Zealand, note that the role of local anesthetic infiltration in this setting is controversial. Some studies show no benefit and others claim prolonged postoperative pain relief.

To investigate, the researchers studied 63 patients undergoing tonsillectomy. They were randomized to receive, under general anesthesia, an injection of 5 mL of 0.5% bupivacaine or 5 mL of isotonic sodium chloride in the peritonsillar space.

Postoperative pain was assessed by means of a visual analogue scale at intervals ranging from 15 minutes to 24 hours postoperatively.

Although there was a trend towards less pain in the bupivacaine group in the immediate postoperative period, overall there was no significant difference between groups. This was also true of postoperative analgesic requirements, hospital stay, and need for anti-emetics.

In light of these findings, the researchers conclude that "the benefit of local anesthetic in controlling pain after tonsillectomy performed with the patient under general anesthesia remains debatable."

Commenting on the findings, Dr. Vasan told Reuters Health that "despite studies such as ours which found no statistical benefit for the use of pre-incisional bupivacaine in tonsillectomy, many otolaryngologists continue to use local anesthetic when performing this operation, based on anecdotal evidence."

Because pain is subjective, he added, accurate assessment is limited and "research into improving our ability to assess pain will greatly contribute to our understanding and management of painful conditions."

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