A comparison of pre‐ and postoperative tonsillar infiltration with bupivacaine on pain after tonsillectomy A pre‐emptive effect?

Abstract

Thirty‐five healthy patients aged 15–36 years scheduled for bilateral tonsillectomy were randomly allocated to receive the following treatments: tonsillar infiltration with 0.25% bupivacaine 5 min before surgical incision (n = 12); identical tonsillar infiltration administered after both tonsils had been surgically removed (n = 12); infiltration with isotonic saline 5 min before the operation (n = 11). There were no significant differences between groups in pain scores (VAS) at rest or during drinking of 100 ml of water as measured at 4 h postoperatively or on the 1st, 2nd, 3rd and 8th postoperative days. Four, five and three patients in the pre‐operative bupivacaine, postoperative bupivacaine, and saline groups, respectively, received one dose of 0.1 mg.kg‐1 morphine intravenously (p = 0.76). Cumulative acetylsalicylic acid requirements during the observation period were not significantly different between groups (p = 0.78). These results suggest that pre‐operative infiltration of 0.25% bupivacaine has no beneficial pre‐emptive analgesic action compared to both an identical treatment administered after tonsillectomy and a placebo. Copyright © 1994, Wiley Blackwell. All rights reserved