Objective: To determine if preemptive analgesia with ropivacaine hydrochlor
ide with or without clonidine hydrochloride decreases pain and hastens reco
very after tonsillectomy.
Design: Prospective, randomized, triple-blinded trial.
Setting: University referral center; pediatric ambulatory practice.
Participants: Sixty-four children, aged 3 to 15 years, undergoing tonsillec
tomy.
Interventions: Patients received injections in the tonsillar fossae of isot
onic sodium chloride, ropivacaine, or ropivacaine plus clonidine prior to t
onsil excision.
Main Outcome Measures: Visual analogue (pain) scale scores at rest and when
drinking, opioid use, recovery time to normal activity, and incidence of s
ymptoms such as otalgia.
Results: Pain was reduced on postoperative day 0 in the ropivacaine-treated
and ropivacaine plus clonidine-treated groups as compared with the isotoni
c sodium chloride-treated group (P < .05). Pain was also decreased in the r
opivacaine plus clonidine-treated group on postoperative days 3 and 5 (P <
.05). Intravenous narcotic use was decreased on day 0 in the ropivacaine-tr
eated and ropivacaine plus clonidine-treated groups (P < .05). Cumulative c
odeine use was similar at day 3 for all patients, but was decreased at day
5 in the ropivacaine plus clonidine-treated group (P < .05). The incidence
of otalgia decreased from 89% (16/18) in the isotonic sodium chloride-treat
ed group to 63% (12/19) in the ropivacaine-treated and 61%(11/18) in the ro
pivacaine plus clonidine-treated groups (P < .01). Recovery to normal activ
ity was shortened from 8.1 <plus/minus> 1.6 days to 5.8 +/- 2.9 days (mean
+/- SD) in the isotonic sodium chloride-treated and ropivacaine plus clonid
ine-treated groups, respectively (P = .03).
Conclusion: Preincisional injection of ropivacaine with clonidine prior to
tonsillectomy has a preemptive analgesic effect that outlasts the local ane
sthetic and decreases pain, opioid use, and the time to return to normal ac
tivity.