EFFECT OF PREOPERATIVE VS POSTOPERATIVE TONSILLAR INFILTRATION WITH LOCAL-ANESTHETICS ON POSTOPERATIVE PAIN AFTER TONSILLECTOMY

Background: Since pre-incisional peritonsillar infiltrations of local anesthetic solutions have been suggested to reduce postoperative pain after tonsillectomy, we compared the efficacy of either pre- or postop erative local anesthetic infiltration upon post-tonsillectomy pain. Me thods: After the induction of general anesthesia, 68 consecutive healt hy patients, ranging in age from 8 to 65 years, were randomly allocate d to either receive peritonsillar infiltration with 0.25% bupivacaine (group 1) or normal saline (group 2) before incision. A third group (g roup 3) had their peritonsillar region infiltrated with 0.25% bupivaca ine after the completion of surgery but before the patients were awake ned from anesthesia. All the patients were treated in the same way in the postoperative period: NSAIDs were given intravenously to adults an d rectally to children. Acetaminophen was given intravenously or recta lly (children aged <15 yr) if additional analgesic support was request ed by the patient. Additional acetaminophen consumption was recorded d aily. Pain scores were assessed on every patient with the use of a vis ual analogue scale (VAS) at rest, 1, 5, 9, 13, 17, 21 and 36 h after s urgery, and also on swallowing during the first postoperative day. Res ults: Global VAS pain scores were lower in the groups treated with bup ivacaine infiltration during the first 24 h after surgery (P<0.05). Su pplementary analgesic consumption was lower in group 3 than in group 2 during the 0-9 h interval immediately following surgery (P<0.05). The re were no statistically significant differences for any other paramet ers between the 3 groups. Conclusion: These results suggest that the t iming of peritonsillar infiltration with bupivacaine is not of clinica l importance and does not affect the quality of postoperative analgesi a in patients undergoing tonsillectomy. (C) Acta Anaesthesiologica Sca ndinavica 40 (1996)