The effects of peritonsillar injections of epinephrine and local anest
hetics before tonsillectomy on blood loss and postoperative pain were
evaluated in a prospective, randomized double-blind trial on 103 child
ren. Patients were randomly as signed into one of three groups: contro
ls given injections of 0.9% NaCl (n=34), patients injected with 0.4 ml
/kg (1:200,000) epinephrine combined with 0.25% bupivacaine (n=33) and
patients given only 1:200,000 epinephrine (n=36). All injections and
operations were performed by the same surgeon (KS). Blood loss was cal
culated by weighing all blood aspirated perioperatively and swabs used
during surgery. Postoperative pain was assessed at regular intervals
by using three methods: (1) use of a visual analogue scale by parents
and nurses to estimate pain; (2) postoperative need for nalbuphin as a
nalgesic; (3) the Hannallah-Broadman semi-objective pain score (includ
ing crying, anxiety, restlessness, and changes in blood pressure). The
mean blood loss in the control group (given Na Cl) was 132 g, which w
as significantly increased when compared with the epinephrine/bupivaca
ine group (85 g) and the group treated with only epinephrine (90 g). H
owever, analysis of the postoperative pain scores did not reveal any s
ignificant differences among groups. These findings indicate that the
peritonsillar injection of bupivacaine does not decrease postoperative
pain, but peritonsillar injections of epinephrine will significantly
reduce blood loss during tonsillectomy.