Learning Track: 8. Acute Pain Management
	
 
Title:
	
Comparison of tramadol and peritonsillar bupivacaine infiltration for postoperative pain relief after tonsillectomy in children: a prospective double blind randomized controlled trial

Author(s):
	
Ameye L., Van de Velde M., Rex S., Teunkens A.

Institute(s):
	
UZ Leuven, Dept of Anaesthesiology, Leuven, Belgium
Text:
	
Background and Goal: Achieving sufficient postoperative analgesia following tonsillectomy in children remains challenging. Conflicting data have been published on the use of local anesthetic infiltration for post-tonsillectomy pain relief. We hypothesized that peritonsillar infiltration with bupivacaine decreases postoperative pain and reduces the incidence of postoperative nausea and vomiting (PONV) after tonsillectomy in children when compared to intravenous (IV) administration of tramadol.

Materials and Methods: After obtaining ethical committee approval and written parental informed consent, 200 patients, between 4 and 10 years old, were included in this prospective, double blind trial and randomised in a 1:1 ratio to either an intraoperative tramadol bolus of 3 mg/kg (administered IV after induction of anesthesia) plus an infiltration with 5 mL of saline at the end of surgery or to an IV bolus injection of placebo after induction of anesthesia and a peritonsillar infiltration with 5 mL bupivacaine 0.25% at the end of surgery. All patients received paracetamol and ketorolac IV at the start of surgery. Primary endpoints were the frequency and dose of postoperative piritramide administration. The pain score was registered using the Wong-Baker Faces rating scale and analgesics were given whenever the given face represented a pain level above patient's pain threshold. Secondary endpoints included the incidence of PONV and oral analgesic requirement during the first 24 hours, incidence of adverse events and discharge times. Groups were compared using the Fisher's Exact test for proportions and the Mann-Whitney-U-test for continuous variables. A p < 0.05 was considered statistically significant.

Results and Discussion: Significantly more patients in the infiltration- than in the tramadol-group required piritramide postoperatively (81% vs 57%; p < .001). Moreover, the total dose of piritramide needed for postoperative analgesia was significantly higher in the infiltration group (median dose [interquartile range]: 0.8[0.5,1.4] mg vs 0.5[0,0.8] mg; p < .001). Groups did not differ with regard to the incidence of PONV during the first 24 hours, oral analgesic consumption, adverse events and discharge times.

Conclusion(s): The results of the present study suggest that infiltration with bupivacaine is associated with an increase in postoperative pain when compared to an intravenous bolus of tramadol.

Ethical Research Declaration:
	
4. Prospective case series involving a new procedure or treatment

Preferred Presentation Type:
	
Clinical or experimental study

Comparison of tramadol and peritonsillar bupivacaine infiltration for postoperative pain relief after tonsillectomy in children: a prospective double blind randomized controlled trial