Tonsillectomy and adenoidectomy pain reduction by local bupivacaine infiltration in children

Experimental data in humans and animals suggest that during surgery, pain impulses enter the CNS creating a hyperexcitable state in spite of general anesthesia. In a prospective double blind study, pain levels in 22 children undergoing tonsillectomy and adenoidectomy under general anesthesia were compared from day of surgery to Day 10. Patients received pre-incisional infiltration with either bupivacaine (A) or saline (B). Subjective pain was assessed by visual analog scale, and objective pain by deglutition time (100 ml). Subjective constant pain was less ( P < 0.05) in group (A) on Day 1: 16 (A) vs. 59 (B) and Day 5: 4 (A) vs. 45 (B). We conclude that local nerve blockade by bupivacaine reduces short- and long-term pain in children undergoing tonsillectomy and adenoidectomy in the presence of general anesthesia.