Prospective Observational Cohort Study of the Effect of Topical Levobupivacaine on Post-Operative Outcomes for Paediatric Patients Undergoing Tonsillectomy

The efficacy of topical anaesthetic in children undergoing tonsillectomy is controversial. It can block sensory signals along C-fibres. Observational study of pain after cold-steel tonsillectomy. Two cohorts; one with topical levobupivacaine soaked swab in the tonsil bed and a second without. FACES (R) scale and visual analogue score were used. Other parameters were oral intake, hospital stays and use of oral morphine. 74-enrolled patients whose parents completed feedback telephone reviews. 37-patients had topical levobupivacaine. There was no difference in pain and analgesic needs between both cohorts on the first two days. Local anaesthesia induced a significant rebound pain on the fifth day. Early use of oral morphine and female gender showed a significant correlation with rebound pain. Topical levobupivacaine showed limited control of early postoperative tonsillectomy pain with rebound pain on the fifth day. Female gender and early opioid use postoperatively increased the risk of rebound pain.