Pre-emptive peritonsillar dexamethasone vs. levobupivacaine infiltration for
relief of post-adenotonsillectomy pain in children: a controlled clinical study.
Author(s): Aysenur D(1), Mine C(1), Ozgur Y(2), Ahmet AH(1), Fuat EA(3), Ilker I(1), Ali
A(1).
Affiliation(s): Author information:
(1)Department of Anesthesiology, Ataturk University Faculty of Medicine, 25240
Erzurum, Turkey. (2)Department of Otorhinolaryngology, Ataturk University Faculty
of Medicine, 25100 Erzurum, Turkey. Electronic address: dryoruk_40@hotmail.com.
(3)Department of Anesthesiology, Sakarya University Faculty of Medicine, Sakarya
Training and Research Hospital, 54187 Sakarya, Turkey.
Publication date & source: 2014, Int J Pediatr Otorhinolaryngol. , 78(9):1467-71
OBJECTIVES: To investigate the effects of the pre-emptive local infiltration of
dexamethasone vs. levobupivacaine on postoperative pain and morbidity in
pediatric adenotonsillectomy patients.
METHODS: A total of 60 patients (32 males and 28 females), aged 3-14 years, were
included in this double-blind prospective randomized controlled clinical study
from September of 2011 until May of 2012. Patients admitted for
adenotonsillectomies after informed consent was obtained from the parents, and
randomized into three groups receiving either dexamethasone sodium phosphate
(Group 1, mean age 5.9 ± 1.6), levobupivacaine with epinephrine (Group 2, mean
age 6.1 ± 2.6), or saline (Group 3, mean age 6.0 ± 3.4). Pain scores at the 1st,
4th, 8th, 12th, 16th, and 20th hours, and first, second, third and seventh days
post-operatively were recorded by the parents using McGrath's face scale. The
operation type, operation time and anesthesia time, the time of the first request
for postoperative analgesia, and the total number of analgesic interventions were
recorded.
RESULTS: Pain scores were revealed in this order: Group 1 (steroid) < Group 2
(levobupivacaine) < Group 3 (saline) at all times (p = 0.000). The anesthesia
times for Group 1 and Group 2 were different (steroid vs. levobupivacaine), and
the time to first analgesic was longer in Groups 1 (steroid) and 2
(levobupivacaine) than in Group 3 (saline) (p < 0.000). The total number of
analgesic interventions was lower in Group 1 (steroid) than in Group 2
(levobupivacaine) and Group 3 (saline) (steroid vs. saline, p = 0.000, and
steroid vs. levobupivacaine, p < 0.05).
CONCLUSION: Peritonsillar dexamethasone infiltration was more effective than both
levobupivacaine and saline in reducing post-tonsillectomy pain. It was proven to
be a safe and effective method.
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