Comparative analysis of local infiltration of tonsillar fossa with bupivacaine versus dexamethasone on post tonsillectomy morbidity

Abstract

Background: Tonsillectomy is one of the most common surgery performed in pediatric otorhinolaryngology. Pain and vomiting being the usual morbidity following this surgery. Aim &

Objective: To compare the efficacy of infiltration of Bupivacaine versus dexamethasone into the tonsillar fossa in postoperative pain and vomiting.

Methods: A total of 100 patients, aged 10-30 years of both sexes with chronic tonsillitis accrued into the study. They were divided in to two groups A and B. Group A was infiltrated with 0.5% bupivacaine (1mg/kg body weight) locally and Group B with dexamethasone (0.15mg/kg bodyweight) locally into the tonsillar bed. All patients underwent tonsillectomy by dissection/snare technique, bleeding was controlled by applying local pressure, and by ligatures, thereby avoiding cauterization. Post tonsillectomy pain assessed by visual analog scale (VAS), nausea and vomiting by absence/presence was compared between both groups.

Results: In Bupivacaine group (A), 86% patients observed analgesic effect by the 1st postoperative hour and by 6th hour all had complete analgesia. In dexamethasone group (B) the analgesic effect started by 12thhour and by 48th hour in all patients (p<0.001). Post-operative occurrence of nausea and vomiting in bupivacaine group (A) was 76% and 30% respectively. However, in dexamethasone group (B), the nausea and vomiting was observed in 10% respectively.

Conclusion: Our study showed that 0.5% bupivacaine reduces immediate post-operative pain significantly as compared to dexamethasone and dexamethasone reduces postoperative nausea and vomiting significantly as compared to 0.5% bupivacaine. There were no adverse reactions or complications due to the additional surgical intervention in both the groups.