Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation

Objective: To evaluate the effects of peritonsillar injection of levobupivacaine with epinephrine in children undergoing adenotonsillectomy, through an intraindividual study. Patients and methods: 20 children (age 6-13 years) undergoing elective tonsillectomy with or without adenoidectomy were enrolled in this prospective, randomized, intraindividual trial. After entubation and just prior to incision, 3 ml of 0.25% levobupivacaine with epinephrine was injected into one peritonsillar region while 0.9% saline was being used for the contralateral side. Amount of intraoperative blood loss, duration of tonsillectomy, postoperative pain, otalgia and hemorrhage were assessed for each side separately. Visual analog scale was used for postoperative pain assessment. Heart rate and mean arterial pressure during and after operation were also observed. The follow-up period after surgery was 10 days. Results: Median visual analog scale values for the levobupivacaine with epinephrine injected side was significantly lower than the saline injected side, during the first postoperative 16 h (p < 0.05). There were also significant differences between the intraoperative blood losses of the two sides (p < 0.05). However; no significant differences were observed with respect to duration of surgery, postoperative otalgia and hemorrhage (p > 0.05). Conclusion: Preincisional injection of levobupivacaine with epinephrine decreases early postoperative pain and intraoperative blood loss as well. (C) 2010 Elsevier Ireland Ltd. All rights reserved.