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Evaluation of the Effects of Sub-Tonsillar Marcaine Injection in Tonsillectomy for Reducing Postoperative Nausea and Vomiting..

Ali Reza Olapour, Mahbobe Rashidi, Reza Akhondzadeh, Reza Baghbanian, Negar Vernasser

Background: Injections of topical analgesics such as lidocaine and bupivacaine control agitation and relieve pain without the unwanted side effects of drugs such as nausea, vomiting, and respiratory failure. Therefore, the present study was performed to determine the possible effect of topical injection of bupivacaine on the reduction of nausea, vomiting, and agitation after tonsillectomy.

Methods: The present study was performed as a double blind randomized controlled clinical trial on 50 patients aged 5 to 12 years under tonsillectomy surgery in Imam Khomeini Hospital in Ahvaz in 2018-2019. Patients were randomly divided into two intervention (I) and control (C) groups, each consisting of 25 patients. Anesthesia was induced with 0.02 mg/kg atropine, 2 µg/kg fentanyl, 4-5 mg/kg sodium thiopental, and 0.5 mg/kg muscle relaxant atracurium, and nasotracheal intubation was performed in patients. Group I received a topical injection of 1 cc of bupivacaine 0.2% (20 mg/4 ml) with epinephrine 0.001% and group C injection received 1 cc of normal saline with epinephrine 0.001%. Pain intensity, the presence of nausea, vomiting, and agitation at 1, 4, 8, 16, and 24 hours after injection were recorded, evaluated, and compared.

Results: The mean age and gender distribution of patients in the two groups were not significantly different (P>0.05). At all measurement times, the mean score of the measurement criterion was significantly higher in the control group (P<0.05). At all times, the mean score of the measurement of the incidence of vomiting and agitation in the control group was higher, but this rate was statistically significant only in 1, 4, and 8 hours after injection in both groups (P<0.05). At all measurement times, the mean score of the pain intensity in the control group was significantly higher (P<0.05).

Conclusion: The results of the present study showed that the sub-tonsillar injection of Marcaine was a safe method for pain control, reduction of nausea, vomiting, and postoperative agitation in children undergoing tonsillectomy.