Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy

Abstract

Abstract Background Tonsillectomy is one of the most commonly performed surgeries in ENT practice. Despite improvements in anesthetic and surgical techniques, post-tonsillectomy morbidities continue to be a significant clinical concern. Pain is the cause of most of the postoperative morbidity after tonsillectomy. An effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice. Aim The present study compares the results between the effect of lidocaine 2% infiltration, lidocaine 10 % spray, and bupivacaine 0.5% spray in the tonsillar bed after tonsillectomy on postoperative pain. Materials and methods The study included a total of 120 patients aged 5–18 years who were candidates for tonsillectomy at the Otorhinolaryngology Department of Alexandria Main University Hospital. The patients were randomly divided into three groups of 40 patients each. Group A received lidocaine 2% (Xylocaine) peritonsillar infiltration 2ml in one tonsillar bed and posterior pillar; group B received lidocaine 10% (Xylocaine) spray 2 puff in one tonsillar bed; group C received bupivacaine 0.5% (Marcaine) solution 2ml in one tonsillar bed spray by syringe and the other tonsillar bed in each group receives pack with similar amounts of normal saline for 5 min as a control group after tonsillectomy before recovery from anesthesia. Results There was no statistical difference between the three studied groups as regards age and sex. There is significant statistical difference according to the frequency of throat pain and ear pain by comparing cases and controls of each group within the first 24 h after surgery. It appears that increased frequency of postoperative throat pain and ear pain is present with the control side (saline). Conclusion Topical application of the tonsillar bed with a local anesthetic after tonsillectomy results in significant reduction of postoperative throat pain and referred otalgia and should be used during surgery for tonsillectomy.