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academies
International Surgery and Ortho Conference
October 25-26, 2017 | Toronto, Canada
Case Rep Surg Invasive Proced 2017 | Volume 1 Issue 3
Comparison between topical and infiltrative analgesia for post–operative pain in tonsillectomy
patients: A double blind randomized controlled experimental study in tertiary care hospital
Montasir Junaid
Armed Forces Hospital Southern Region, Kingdom of Saudi Arabia
Introduction:
Pain management after tonsillectomy has always
been a challenge for the surgeon. Since immediate post-
operative pain prohibits the patient from prompt recovery,
leads to dissatisfaction of patient and delays in terms of
proper diet intake eventually leading to complications such
as infection, dehydration and secondary hemorrhage. Pain
after tonsillectomy is maximum in first 72 hours and must be
adequately controlled. Numerous studies have been done to
show the effect of topical and infiltrative analgesia used per or
post tonsillectomy but genuine paucity of research to compare
both, still exists in literature.
Material & Methods:
The study was conducted as an
experimental, double blind randomized controlled trial at
Jinnah medical and dental college hospital over the period of
3 year (2012-2015). A total of 180 patients with predominant
male population with minimum age of 6 years and maximum
of 37 years undergoing elective tonsillectomy were included.
Two methods of analgesia administrations were used; topical
and infiltrative. Topical analgesia was applied via soaked pack
of analgesic agent after tonsillectomy in tonsillar fossa while
infiltrative analgesia was applied via syringe over tonsillar
pillars post tonsillectomy. The patients were randomly divided
into six groups; Group 1: Topical 0.5% bupivacaine, Group 2:
topical 2% lidocaine, Group 3: topical normal saline (placebo)
Group 4: infiltrative 0.5 % bupivacaine Group 5: infiltrative 2
% lidocaine and Group 6: infiltrative normal saline (placebo).
The Visual analogue pain scale was used to assess the pain
at rest, swallowing and speaking at 4, 8, 12 and 16 hours and
at discharge. Frequency and type of analgesia (primary and
additional secondary analgesia) used in ward and at home after
discharge were noted along with any complications.
Results:
Groupwith infiltration of 0.5%bupivacaine showed the
most promising results in terms of decreasing pain in first 24
hourswhenassessed for speaking, swallowing andat rest.While
the use of analgesia was significantly lower in the Infiltration
of 0.5% bupivacaine group when compared with other groups.
Further this group was the only one which showed no use of
analgesia in 3 patients post operatively while use of additional
second analgesia was minimal and the use of opioid analgesics
was almost nil with this group. Most common complication in
our study was secondary hemorrhage. Fewer patients used
secondary analgesic at home.
Conclusion:
Post tonsillectomy pain can be adequately
controlled via infiltration with 0.5% bupivacaine and thus
reduces pain in swallowing, speaking, and at rest, while the
other analgesic agent such as xylocaine 2%proves to be another
option if infiltration is used rather than topical pack.
Speaker Biography
Montasir Junaid is an ENT Specialist with special interest in Otology and Head and Neck
Surgery. He has worked as Assistant Professor in Pakistan and currently is a visiting
faculty in Armed Forces Hospital southern region, Saudi Arabia. He has more than 25
publications and two books published as Author and Co-Author. He is also an Active
Member of Pakistan Cochlear Implant Program, where cochlear implants are being
done free of charge on financially challenged pediatric patients with complete hearing
loss.
e:
montsj@gmail.com