Modified infiltration technique in tonsillectomy: expanded case report of 25 children

Objective: To introduce a modified infiltration technique of anesthetic mixture in order to reduce post-tonsillectomy pain based on histo-anatomic observations and tonsil's innervation detection. Design: Histo-anatomic, expanded case report. Setting: Tertiary care facility in Beirut, Lebanon. Patients: One hundred and seven patients who underwent tonsillectomy allocated in three groups. Interventions: Histo-anatomic observations were studied in 62 patients (group, I). Nerve-stimulator detection was performed in group II (20 children). An expanded case report of 25 children (group III) was conducted using a modified infiltration technique based on the findings of the histo-anatomic observations and nerve detection. Outcome measures: Post-operative pain at 0, 6, 12 h and once daily for the 10-day follow-up period, hemodynamic stability, hospital stay, patient satisfaction and analgesics consumption were assessed. Results: The nerve-stimulator confirmed the histo-anatomic findings by strong contractions of the superior constrictor muscle, soft palate and uvula when the needle is mainly in the middle part of the peritonsillar area where the glossopharyngeal nerve branches predominate. No visual analogue scale median exceeded 1 for any child at any predetermined time interval, only three children (12%) required opoiods during the follow-up period. All children (100%) were discharged the same day, only 4% of parents were unsatisfied. Hemodynamic stability was maintained during pre- and post-operation. Conclusion: This modified technique with minimal volume of anesthetic mixture seems to reduce post-operative pain in tonsillectomy patients; a randomized double-blinded prospective study was designed based on the findings in this initial series of children. (C) 2004 Elsevier Ireland Ltd. All rights reserved.