Preincisional bupivacaine in posttonsillectomy pain relief - A randomized prospective study

Objective: To determine the effect of preincisional bupivacaine hydrochloride infiltration on postoperative pain after tonsillectomy. Design: Prospective, randomized, double-blind clinical trial. Setting: A secondary/tertiary referral center in Christchurch, New Zealand. Patients: A volunteer sample of 70 patients, aged 16 to 42 years, with recurrent tonsillitis. Seven patients were excluded. Interventions: After randomization, one group received 5 mL of 0.5% bupivacaine hydrochloride in the peritonsillar space, with the patient under general anesthesia. The other group received 5 mL of isotonic sodium chloride solution, with the patient under general anesthesia. Both groups underwent surgery with a standardized surgical and anesthetic technique. Main Outcome Measures: Postoperative pain was assessed with a visual analog scale at 15 minutes and 1, 4, 12, 16, and 24 hours after the procedure. Postoperative analgesic requirement, length of admission, and antiemetic requirement were also assessed. Results: No statistical difference was found between the 2 groups for postoperative pain by means of the visual analog scale at any time interval, nor was any statistical difference found for the other variables measured. A trend toward less pain in the immediate postoperative period in the group receiving bupivacaine was noted. Conclusion: No statistically significant benefit is found for use of preincisional bupivacaine in tonsillectomy.