SpringerLink
Log in

To Compare the Effects of Post-tonsillectomy Intra-operative Infiltration of Ropivacaine Versus Bupivacaine in Tonsillar Fossa

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Tonsillectomy is one of the most common surgical procedures practiced in Otorhinolaryngology. A significant obstacle for the speedy and smooth recovery is early post- operative pain. Pain leads to negative outcomes such as poor intake, tachycardia, anxiety, delayed wound healing and insomnia. Aim to assess and compare the effect of post-incisional infiltration of 0.75% Ropivacaine v/s 0.5% Bupivacaine on post tonsillectomy pain, the on start of oral intake and stay in hospital and to investigate any complications that can arise due to infiltration of the said drugs. 60 Patients above the age of 5 years were posted for tonsillectomy or adenotonsillectomy under general anesthesia. Patients were blinded about the group in which they will be enrolled. Group A received Inj. ropivacaine (0.75%) 2 ml and Group B: received Inj. Bupivacaine (0.50%) 2 ml in each fossa. After surgery, no analgesics were given & patients were observed for the intensity of post-operative pain in the immediate post-operative period, at 2, 4, 6, 12, 24, 48 h and further if not discharged using VISUAL ANALOGUE SCORE (VAS) and VERBAL RATING SCALE(VRS). Post-operative pain assessment was done using VAS and VRS at 2nd, 4th, 6th, 12th, 24th and 48th hour which was found to be lower in Group ‘A’. Patients in Group ‘A’ also started their oral intake sooner, had lesser hospitalization days than group ‘B’ patients. Longer time for Rescue analgesic and reduced total dose of analgesic required was seen in Group A compared to Group B. This comparative study on Post-incisional infiltration of 2 ml 0.75% Ropivacaine v/s 2 ml 0.5% Bupivacaine has shown that Ropivacaine is a more effective drug in reducing post-operative pain in comparison to Bupivacaine, proven statistically.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Mehta DM (2019) A Randomised double blind clinical trial to compare the effects of preincisional infiltration of ropivacaine v/s bupivacaine on post tonsillectomy pain relief. J Med Sci Clin Res [Internet]. 7(5). https://www.researchgate.net/publication/333223115_A_Randomised_double_blind_clinical_trial_to_compare_the_effects_of_preincisional_infiltration_of_ropivacaine_vs_bupivacaine_on_post_tonsillectomy_pain_relief

  2. Robinson SR, Purdie GL (2000) Reducing post-tonsillectomy pain with cryoanalgesia: a randomized controlled trial. Laryngoscope 110(7):1128–1131

    Article  CAS  PubMed  Google Scholar 

  3. Taylor A, McLeod G (2020) Corrigendum to ‘Basic pharmacology of local anaesthetics’[BJA Education 20 (2020) 34–41]. BJA Ed 20(4):140

    Article  CAS  Google Scholar 

  4. Giannoni C, White S, Enneking FK, Morey T (2001) Ropivacaine with or without clonidine improves pediatric tonsillectomy pain. Archiv Otolaryngol-Head Neck Surg 127(10):1265–1270

    Article  CAS  Google Scholar 

  5. Katz J, Kavanagh BP, Sandler AN, Nierenberg H, Boylan JF, Friedlander M, Shaw BF (1992) Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. https://pubmed.ncbi.nlm.nih.gov/1519781/

  6. JF B, GR S. (1990) Molecular mechanisms of local anesthesia: a review. Anesthesiology [Internet]. 72(4):711–34. https://pubmed.ncbi.nlm.nih.gov/2157353/

  7. Jx M, Bj D (2004) Pharmacokinetics of local anaesthetics in infants and children. Clin Pharmacokinet [Internet]. 43(1):17–32. https://pubmed.ncbi.nlm.nih.gov/14715049/

  8. Akoglu E, Akkurt BCO, Inanoglu K, Okuyucu S, Daglı S (2006) Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: a randomized controlled study. Int J Pediatric Otorhinolaryngol 70(7):1169–1173

    Article  Google Scholar 

  9. Unal Y, Pampal K, Korkmaz S, Arslan M, Zengin A, Kurtipek O (2007) Comparison of bupivacaine and ropivacaine on postoperative pain after tonsillectomy in paediatric patients. Int J Pediatric Otorhinolaryngol 71(1):83–87

    Article  Google Scholar 

  10. Tajima K, Sato S, Miyabe M (1997) A case of acute pulmonary edema and bulbar paralysis after local epinephrine infiltration. J Clin Anesth 9(3):236–238

    Article  CAS  PubMed  Google Scholar 

  11. Park AH, Pappas AL, Fluder E, Creech S, Lugo RA, Hotaling A (2004) Effect of perioperative administration of ropivacaine with epinephrine on postoperative pediatric adenotonsillectomy recovery. Archiv Otolaryngol-Head Neck Surg 130(4):459–464

    Article  Google Scholar 

  12. Arikan OK, Ozcan S, Kazkayasi M, Akpinar S, Koc C (2006) Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief: double-blind, randomized, placebo-controlled intraindividual study. J Otolaryngol 35(3):167–172

    PubMed  Google Scholar 

  13. Arikan OK, Sahin S, Kazkayasi M, Muluk NB, Akpinar S, Kilic R (2008) High-dose ropivacaine versus bupivacaine for posttonsillectomy pain relief in adults. J Otolaryngol Head Neck Surg 37(6):836–843

    PubMed  Google Scholar 

  14. Kasapoglu F, Kaya FN, Tuzemen G, Ozmen OA, Kaya A, Onart S (2011) Comparison of peritonsillar levobupivacaine and bupivacaine infiltration for post-tonsillectomy pain relief in children: placebo-controlled clinical study. Int J Pediatric Otorhinolaryngol 75(3):322–326

    Article  Google Scholar 

  15. Grubb T, Lobprise H (2020) Local and regional anaesthesia in dogs and cats: Overview of concepts and drugs (Part 1). Veterinary Med Sci 6(2):209–217

    Article  Google Scholar 

  16. Özkiriş M, Kapusuz Z, Saydam L (2012) Comparison of ropivacaine, bupivacaine and lidocaine in the management of post-tonsillectomy pain. Int J Pediatric Otorhinolaryngol 76(12):1831–1834

    Article  Google Scholar 

  17. Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, Patel MM (2011) Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 144:S1–S30

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of ENT and Head Neck Surgery, Maharishi Markandeshwar College of Medical Sciences and Research, Ambala, Haryana, India

    B. Nitin

  2. Department of ENT and Head Neck Surgery, Gian Sagar Hospital and Medical College, Banur Rajpura, Punjab, India

    Manish Gupta

Authors
  1. B. Nitin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manish Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Nitin.

Ethics declarations

Conflict of interest

None.

Ethics Approval

Institutional Ethical Committee Approval taken before the study.

Informed Consent

Informed Written Consent about the study taken before every surgery in the patient’s own vernacular language.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nitin, B., Gupta, M. To Compare the Effects of Post-tonsillectomy Intra-operative Infiltration of Ropivacaine Versus Bupivacaine in Tonsillar Fossa. Indian J Otolaryngol Head Neck Surg 76, 1805–1818 (2024). https://doi.org/10.1007/s12070-023-04417-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-023-04417-6

Keywords

Search

Navigation