[ value of intraopepvative use of topical bupivacaine combined with rectal diclofenac on post tonsillectomy pain and oral intake in children]

ABSTRACT

To evaluate the efficacy of intraoperative topical bupivacaine combined with rectal diclofenac in reducing postoperative pain and facilitating early oral intake. Between 1 January 2005 and 1 January 2008 one hundred fifty patients aged 5-13 years underwent elective tonsillectomy with adenoidectomy in Prince Rashed Ben Al-Hassan hospital and Prince Zaid Ben Al-Hussein hospital, Jordan. Patients were randomized into two groups; group [1] 75 patients received 0.5% bupivacaine 2 mg/kg soaked swabs [2x2] inch tightly packed in their tonsillar fossa for five minutes after complete and good hemostasis. Group [2]; 75 patients had soaked swab with normal saline for five minutes also. Three patients excluded for failure to complete the postoperative data and another two patients for postoperative bleeding from the adenoid site. Data from 145 patients were analyzed as five patients were excluded. When comparing the two groups for postoperative pain, less pain was noted in the bupivacaine group, the difference was statistically significant for the first 8 hours and also after 24 hours among treatment group who did not complain of pain postoperatively. The mean time difference of first drink and eat between the two groups was statistically significant. No major complications such as airway obstruction, dehydration or local anesthetic toxicity developed. We concluded that topical bupivacaine combined with rectal diclofenac is safe and easy to administer. Topical bupivacaine use combined with diclofenac reduces postoperative pain and facilitate early oral intake in children