Comparison of Local application versus Infiltration of Bupivacaine for post Tonsillectomy pain in Adults

Objective: To compare whether an individual can appreciate pain relief with local Bupivacaine applied to the tonsillar fossae following tonsillectomy, either topically or as a sub mucosal injection. Study Design: Randomized Control trial. Place and Duration: Department of ENT/ Head Neck surgery, Combined Military Hospital Peshawar, from January 2007 to July 2008. Materials and Methods: 128 patients of either gender, aged 18 to 40 years were randomized into two groups. Group (1) had, either tonsillar fossa randomly packed with a gauze piece soaked in 5 ml of 0.5% bupivacaine for 5 minutes, while group (2) was given a sub mucosal injection of 5 ml bupivacaine (2.5 mg/ml) randomly in either tonsillar fossa. The untreated fossae in all patients were taken as control. Following tonsillectomy the pain intensity was documented by asking patients in both groups to express their pain on a visual analogue scale (VAS) (0- 100 mm) at 1, 2, 4 and 8 hours. Results: A substantial number of the patients failed to experience pain relief on the side of local anaesthetic (bupivacaine) application. Conclusion: Bupivacaine application provides no appreciable pain control in post tonsillectomy patients irrespective of the application method.