Comparison of ropivacaine, bupivacaine and lidocaine in the management of post-tonsillectomy pain

Abstract Objectives To compare the efficacy of preoperative peritonsillar injection of ropivacaine, bupivacaine and lidocaine for pediatric tonsillectomy. Patients and methods Between March 2009 and April 2012, 120 patients (66 males and 54 females) between ages of 4 and 13 years were included to the study. After informed consent was obtained from the parents, the patients were randomized into four groups. In Group 1 (31 patients, mean age 8.40 ± 4.05 years) received topical lidocaine hydrochloride with 1:100,000 epinephrine was applied to surgical bed following tonsillectomy. Group 2 (29 patients, mean age 8.15 ± 4.20 years) and group 3 (31 patients, mean age 7.75 ± 3.95 years) were administered 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine and 0.5% ropivacaine respectively. In Group 4 (29 patients, mean age 8.15 ± 4.20 years) topical 0.9% saline was used. The operation time, postoperative pain, amount of intraoperative blood loss, postoperative hemorrhage and complications were assessed. The intensity of pain was scored on a visual analogue scale. The patients were followed up for 3 weeks after surgery. Results The difference between mean operative time of the three groups against saline injected group was statistically significant ( p < 0.001). The difference between mean intraoperative blood loss of the lidocaine group against three groups was statistically significant ( p < 0.001). None of the patients in four groups experienced primary and secondary hemorrhage. The difference between mean pain score between ropovacaine and bupivacaine groups was not statistically significant ( p > 0.001). The difference between mean pain score of the two groups against lidocaine and saline groups was statistically significant ( p < 0.001). Conclusion Ropivacaine infiltration is as effective as bupivacaine for post-tonsillectomy pain management in children. In view of potential side effects of bupivacaine–epinephrin combination, ropivacaine is a safer choice, for post-tonsillectomy pain relief.