Vocal cord paralysis as a consequence of peritonsillar infiltration with bupivacaine

Reduction of postoperative pain is an important goal in the perioperative m anagement of tonsillectomy patients. This is particularly the case for chil dren, who often exhibit resistance to intramuscular or rectal administratio n of drugs. Peritonsillar bupivacaine infiltration, a relatively safe metho d of pain control, is in some centers frequently used by otolaryngologists for pain relief. We present the case of a 5-year-old girl who developed bil ateral vocal cord paralysis following preoperative peritonsillar bupivacain e infiltration. After an uneventful tonsillectomy and extubation, stridor a nd respiratory distress developed. Bilateral vocal cord paralysis was seen on laryngoscopy. The patient was reintubated and five hours later was succe ssfully extubated without further sequelae. Anesthesiologists and surgeons should be aware of this uncommon complication than can occur with the use o f peritonsillar bupivacaine infiltration for pain control in tonsil surgery .