Peritonsillar dexamethasone–bupivacaine vs. bupivacaine infiltration for post-tonsillectomy pain relief in children: a randomized, double-blind, controlled study

Post-tonsillectomy pain is one of the most frequent morbidities of tonsillectomy surgery. Currently, there is no standard protocol for post-tonsillectomy pain control. In our study, we aimed to compare the effects of perioperative peritonsillar dexamethasone–bupivacaine and bupivacaine-alone infiltration on pain control in pediatric patients.

This prospective, randomized, double-blind, controlled clinical trial was conducted between February 2018 and May 2018 in a single-center tertiary education and research hospital, otorhinolaryngology/head and neck surgery clinic, under general anesthesia, which included 120 pediatric patients between the ages of 2–12 (mean 5.7 ± 1.8), and who were with ASA (American Society of Anesthesiologists) I–II classification. Patients were randomly divided into three groups as 40 participants in each group. Group 1 consisted of patients who were injected with dexamethasone–bupivacaine into their peritonsillar region, group 2 consisted of patients who were injected with bupivacaine only, and group 3 consisted of patients who were injected with saline only as the control group. FLACC (face, legs, activity, cry, consolability) Scale and Wong-Baker FACES^® Pain Rating Scale (WBS) were used for early and late period postoperative pain scoring. Patients with pain score ≥ 4 were treated with paracetamol rescue analgesia. Side effects such as nausea, vomiting and bleeding were recorded. Data of all groups were compared statistically and p ≤ 0.05 was considered statistically significant.

In our study, preoperative local dexamethasone–bupivacaine infiltration in pediatric patients was shown to be more effective than bupivacaine-only and serum-only infiltration for early and late post-tonsillectomy pain control.