Evaluation of the effect of Bupivacaine (Marcaine) in reducing early post tonsillectomy pain.

OBJECTIVE: To evaluate the effectiveness of bupivacaine as topically applied in reducing post tonsillectomy pain within the first 24 hours. METHODS: This prospective, randomized, placebo-controlled, intra-individual, single-blind study was conducted at the Otolaryngology Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia from October 2009 until March 2010. Thirty-five patients underwent cold knife tonsillectomy. One tonsillar fossa was packed with gauze soaked in plain 0.25% bupivacaine, while the other tonsillar fossa was packed with gauze soaked in normal saline (the control side). Both gauzes were applied for 5 minutes. The patients' pain was evaluated on each side using the visual analog scale at 2, 4, 6, 12, and 24 hours post-operatively. RESULTS: The reduction in pain at 2 and 4 hours was statistically insignificant compared with the control side. However, at 6, 12, and 24 hours post operatively, the reduction of pain was statistically significant. CONCLUSION: Topical application of bupivacaine at a 0.25% concentration appears to a considerable degree of analgesia within the first 24 hours post tonsillectomy.

Monopolar electrodissection versus cold dissection tonsillectomy among children.

OBJECTIVE: To compare cold dissection to monopolar tonsillectomy in terms of operative time, intraoperative bleeding, post operative bleeding, and pain. METHODS: The study included 100 children who underwent tonsillectomy between January 2002 and January 2004. This study was carried out at King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Patients were randomly selected to have either the right or left tonsils removed by either technique (cold dissection or monopolar dissection technique). We compared both techniques in each side on the same patient. RESULTS: There was no significant difference in operative time between both sides by either technique, however, when the patients were grouped into < or =3 minutes and >3 minute groups, the result showed that a greater number of patients were operated up on < or =3 minutes by diathermy procedure compared to dissection method (44 versus 67) (p=0.0011). Blood loss was minimal with the diathermy technique; averaging 25.37 ml compared to 88.5 ml for cold dissection tonsillectomy. There was a significant increase in postoperative pain on the first postoperative day in the diathermy group compared to the cold dissection group (27% versus 12%) (p=0.0151). However, there was no significant difference in pain between both sides in the first 24 hours and from the 2nd to 10th postoperative days. CONCLUSION: Monopolar dissection tonsillectomy is a safe technique. It significantly reduces the operative time and intraoperative blood loss. However, it causes more pain on the 1st post operative day, while on the rest of the days until the 10th post operative day, there was no significant difference in pain between two sides.