Peritonsillar Infiltration with Tramadol and Bupivacaine to Relief Post-Tonsillectomy Pain in Children
DOI:
https://doi.org/10.70863/karbalajm.v13i2.814Keywords:
Tonsillectomy, Postoperative pain, Tramadol, BupivacaineAbstract
Background:
Tonsillectomy is one of the most frequently performed surgical interventions in children. Pain control for pediatric’ patients undergoing tonsillectomy remains problematic.
Objectives:
To investigate the effects of peritonsillar infiltration of tramadol and bupivacaine in reducing post-tonsillectomy pain in children.
Patients and methods:
A Quasi-interventional study, 150 children aged 5-15 years, who were scheduled for elective tonsillectomy or adenotonsillectomy at the ENT department. Patients were randomly allocated into three groups with 50 patients in each. Group A received peritonsillar infiltration of tramadol, group B received peritonsillar infiltration of 5ml of 2 % Bupivacaine. While equal quantities of isotonic saline were used for infiltration in the control group (C). In all groups, peritonsillar infiltration was carried out after tonsillectomy but before to tracheal extubation. Postoperative pain was evaluated by a visual analog scale (VAS) and compared for the three groups.
Results
No significant difference between the groups in regards to age, gender, weight, type of surgery, and duration of the operation. The tramadol group shows a significantly lower pain score in the early postoperative hours in comparison to the bupivacaine and control groups. Further, the bupivacaine group shows a significantly lower pain score in comparison to the control group within the first hour postoperatively. No significant difference was found between the groups regarding nausea and vomiting side effects.
Conclusions:
Peritonsillar infiltration of tramadol provides better post-tonsillectomy pain control in the immediate postoperative period than bupivacaine or placebo without obvious side effects. Bupivacaine was superior to placebo in reducing early postoperative pain.
References
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22. Ayatollahi V, Behdad S, Hatami M, Moshtaghiun H, Baghianimoghadam B. Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a doubleblinded randomized lacebocontrolled clinical trial. Croatian medical journal. 2012 Apr 15;53(2):155-61
23. de Sousa Caixeta JA, Sampaio JC, da Costa PS, Avelino MA. Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo. European Archives of Oto-Rhino-Laryngology. 2020 Mar 10:1-8.
24. Teunkens A, Vermeulen K, Peters M, Fieuws S, Van de Velde M, Rex S. Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled trial. European Journal of Anaesthesiology (EJA). 2019 Mar 1;36(3):206-14.
25. Dabirmoghaddam P, Baradarnfar MH, Ayatallahi V, Shakibapoor M. The effect of intravenous Dexamethasone and local Bupivacaine in post-tonsillectomy vomiting and pain. Tehran University Medical Journal TUMS Publications. 2007 Aug 10;65(5):65-9.
26. Rajput SD, Patel AV, Prajapati MB, Padavi DS. Role of Preincisional Peritonsillar Infiltration of Bupivacaine in Postoperative Pain Relief in Tonsillectomy Patients. Indian Journal of Otolaryngology and Head & Neck Surgery. 2019 Oct 1;71(1):610-3.
27. Peyvandi A, Roozbahany NA, Niknazar S, Mahani MH. Comparison of Peritonsillar Infiltration of Lidocaine and Bupivacaine for Management of Postoperative Pain of Tonsillectomy. Prensa Med Argent. 2016;102(4):2.
28. Sun J, Wu X, Meng Y, Jin L. Bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children: a meta-analysis. International journal of pediatric otorhinolaryngology. 2010 Apr 1;74(4):369-73. Int Arch Otorhinolaryngol
29. Junaid M, Halim MS, Onali MA, Qadeer S, Khan HU, Ali NS. Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial. International archives of otorhinolaryngology. 2020 Mar;24(1):e62-7.
30. Vasan NR, Stevenson S, Ward M. Preincisional bupivacaine in posttonsillectomy pain relief: a randomized prospective study. Archives of Otolaryngology–Head & Neck Surgery. 2002 Feb 1;128(2):145-9.
2. Nikandish R, Maghsoodi B, Khademi S, Motazedian S, Kaboodkhani R. Peritonsillar infiltration with bupivacaine and pethidine for relief of post‐tonsillectomy pain: a randomised double‐blind study. Anaesthesia. 2008 Jan;63(1):20-5.
3. Hansen J, Shah RD, Benzon HA. Management of pediatric tonsillectomy pain: a review of the literature. Ambulatory Anesthesia. 2016;3:23.
4. Sood AS, Pal P, Gill GS. Peritonsillar Ropivacaine Infiltration in Paediatric Tonsillectomy: A Randomised Control Trial. Iranian Journal of Otorhinolaryngology. 2020 Jul 1;32(4):207-12.
5. Heiba MH, Atef A, Mosleh M, Mohamed R, El-Hamamsy M. Comparison of peritonsillar infiltration of tramadol and lidocaine for the relief of post-tonsillectomy pain. The Journal of Laryngology & Otology. 2012 Nov;126(11):1138-41. .
6. Tan GX, Tunkel DE. Control of pain after tonsillectomy in children: a review. JAMA Otolaryngology–Head & Neck Surgery. 2017 Sep 1;143(9):937-42.
7. Dumlu EG, Tokaç M, Öcal H, Durak D, Kara H, Kılıç M, Yalçın A. Local bupivacaine for postoperative pain management in thyroidectomized patients: a prospective and controlled clinical Adv Biomed Res. 2015; 4: 132.
8. Honarmand A, Safavi M, Naghibi K, Attari M, Soltani M, Amoushahi M, Sadeghipanah F. Preemptive peritonsillar infiltration with bupivacaine in combination with tramadol improves pediatric post-tonsillectomy pain better than using bupivacaine or tramadol alone: A randomized, placebo-controlled, double blind clinical trial. Advanced biomedical research. 2015;4.
9. El Daly A, Abd El Naby M, Emad P. Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy. The Egyptian Journal of Otolaryngology. 2019; 35(2):173-181.
10. Miotto K, Cho AK, Khalil MA, Blanco K, Sasaki JD, Rawson R. Trends in tramadol: pharmacology, metabolism, and misuse. Anesthesia & Analgesia. 2017 Jan 1;124(1):44-51.
11. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clinical pharmacokinetics. 2004 Nov 1;43(13):879-923.
12. Rossi S. Adelaide: The Australian Medicines Handbook Unit Trust.(2013 ed.) ISBN 978-0-9805790-9-3.
13. Hitchings A, Lonsdale D, Burrage D, Baker E. The top 100 drugs: clinical pharmacology and practical prescribing. Elsevier Health Sciences; 2018 Oct 25.
14. Beigh Z, Ul Islam M, Ahmad S, Pampori RA. Effects of peritonsillar injection of tramadol and adrenaline before tonsillectomy. Iranian journal of otorhinolaryngology. 2013 Jun;25(72):135.
15. Aydoğdu İ, Atar Y, Saltürk Z, Aydoğdu Z, Parmaksiz O. Preoperative Anxiety and Postoperative Pain Levels in Patients Undergoing Tonsillectomy. InKBB-Forum: Elektronik Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 2019 Aug 29; 18(3):188-192.
16. Postier AC, Chambers C, Watson D, Schulz C, Friedrichsdorf SJ. A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials. PAIN Reports. 2020 Mar 1;5(2):e819.
17. Persino PR, Saleh L, Walner DL. Pain control following tonsillectomy in children: a survey of patients. International journal of pediatric otorhinolaryngology. 2017 Dec 1;103:76-9.
18. Akkaya T, Bedirli N, Ceylan T, Matkap E, Gulen G, Elverici O, Gumus H, Akin I. Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy. European Journal of Anaesthesiology (EJA). 2009 Apr 1;26(4):333-7.
19. Atef A, Fawaz AA. Peritonsillar infiltration with tramadol improves pediatric tonsillectomy pain. European archives of oto-rhino-laryngology. 2008 May 1;265(5):571-4.
20. Ugur KS, Karabayirli S, Demircioğlu Rİ, Ark N, Kurtaran H, Muslu B, Sert H. The comparison of preincisional peritonsillar infiltration of ketamine and tramadol for postoperative pain relief on children following adenotonsillectomy. International Journal of Pediatric Otorhinolaryngology. 2013 Nov 1;77(11):1825-9.
21. Ugur MB, Yılmaz M, Altunkaya H, Cinar F, Ozer Y, Beder L. Effects of intramuscular and peritonsillar injection of tramadol before tonsillectomy: a double blind, randomized, placebo-controlled clinical trial. International journal of pediatric otorhinolaryngology. 2008 Feb 1;72(2):241-8.
22. Ayatollahi V, Behdad S, Hatami M, Moshtaghiun H, Baghianimoghadam B. Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a doubleblinded randomized lacebocontrolled clinical trial. Croatian medical journal. 2012 Apr 15;53(2):155-61
23. de Sousa Caixeta JA, Sampaio JC, da Costa PS, Avelino MA. Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo. European Archives of Oto-Rhino-Laryngology. 2020 Mar 10:1-8.
24. Teunkens A, Vermeulen K, Peters M, Fieuws S, Van de Velde M, Rex S. Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled trial. European Journal of Anaesthesiology (EJA). 2019 Mar 1;36(3):206-14.
25. Dabirmoghaddam P, Baradarnfar MH, Ayatallahi V, Shakibapoor M. The effect of intravenous Dexamethasone and local Bupivacaine in post-tonsillectomy vomiting and pain. Tehran University Medical Journal TUMS Publications. 2007 Aug 10;65(5):65-9.
26. Rajput SD, Patel AV, Prajapati MB, Padavi DS. Role of Preincisional Peritonsillar Infiltration of Bupivacaine in Postoperative Pain Relief in Tonsillectomy Patients. Indian Journal of Otolaryngology and Head & Neck Surgery. 2019 Oct 1;71(1):610-3.
27. Peyvandi A, Roozbahany NA, Niknazar S, Mahani MH. Comparison of Peritonsillar Infiltration of Lidocaine and Bupivacaine for Management of Postoperative Pain of Tonsillectomy. Prensa Med Argent. 2016;102(4):2.
28. Sun J, Wu X, Meng Y, Jin L. Bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children: a meta-analysis. International journal of pediatric otorhinolaryngology. 2010 Apr 1;74(4):369-73. Int Arch Otorhinolaryngol
29. Junaid M, Halim MS, Onali MA, Qadeer S, Khan HU, Ali NS. Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial. International archives of otorhinolaryngology. 2020 Mar;24(1):e62-7.
30. Vasan NR, Stevenson S, Ward M. Preincisional bupivacaine in posttonsillectomy pain relief: a randomized prospective study. Archives of Otolaryngology–Head & Neck Surgery. 2002 Feb 1;128(2):145-9.
Published
2021-02-02
How to Cite
Khudhair, E. S., Abutiheen, A. A. K., Dakhal, H. J., & Yassin, A. G. (2021). Peritonsillar Infiltration with Tramadol and Bupivacaine to Relief Post-Tonsillectomy Pain in Children. Karbala Journal of Medicine, 13(2), 2377–2383. https://doi.org/10.70863/karbalajm.v13i2.814
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Research Articles
