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.