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Comparison of local infiltration of ropivacaine, bupivacaine, topical application of sucralfate in the tonsillar fossa on post-tonsillectomy pain

Background: Tonsillectomy is one of the most common surgeries performed in paediatric otorhinolaryngology. The most common morbidity of the surgery is the post operative pain. As there is increase in trend of tonsillectomy as day care surgery adequate postoperative analgesia becomes a very important issue.

Objective: To compare the efficacy of infiltration of ropivacaine 0.2% and bupivacaine 0.25% and topical application of sucralfate in to the tonsillar fossa in postoperative pain management.

Method: 120 patients aged 5–12 years, undergoing tonsillectomy were enrolled in the study. They were randomized into 4 groups. In group A (n=30) cases were infiltrated with ropivacaine into the tonsillar fossa; in group B (n=30), bupivacaine was infiltrated and in group C (n=30), the fossa was painted with sucralfate solution after the surgery; group D (n=30) was the control group where normal saline was infiltrated to the fossa following surgery. Visual analogue scale & Wong Baker facial pain scale were used to measure the intensity of pain postoperatively.

Results: At 4h postoperatively, the pain scores of all 3 study groups were significantly lesser (p<0.05) than control group (Group A - 3.53, B – 3.70, C- 3.80, D- 5.20). The VAS & facial pain scores over the entire postoperative period were consistently lower in the study groups than in the control. The reduction of throat pain was significantly lower in the ropivacaine & sucralfate group compared with bupivacaine & control groups.
Conclusion: Our study demonstrates that topical sucralfate and ropivacaine are equally effective and safe and improves post tonsillectomy analgesia. They provide better analgesia compared to bupivacaine.

Author(s): Goutham M K Ravishankara S Sudhir M Naik Sathya P Mohan Appaji Shankarnarayan Bhat