Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled trial.
Analgesics, Opioid
/ administration & dosage
Anesthesia, Local
/ methods
Anesthetics, Local
/ administration & dosage
Bupivacaine
/ administration & dosage
Child
Child, Preschool
Double-Blind Method
Female
Humans
Infusions, Intravenous
Male
Pain, Postoperative
/ diagnosis
Pirinitramide
/ administration & dosage
Tonsillectomy
/ adverse effects
Journal
European journal of anaesthesiology
ISSN: 1365-2346
Titre abrégé: Eur J Anaesthesiol
Pays: England
ID NLM: 8411711
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
pubmed:
15
1
2019
medline:
28
5
2019
entrez:
15
1
2019
Statut:
ppublish
Résumé
Adenotonsillectomy is a frequently performed procedure in paediatric day-case surgery. Postoperative pain can be significant and standard analgesia protocols are often insufficient. Our primary objective was to investigate if infiltration of the peritonsillar space with bupivacaine would reduce the need for postoperative opioids compared with pre-emptive intravenous tramadol. A double-blind, randomised controlled trial. Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from January 2012 to September 2016. Two hundred children, between 4 and 10 years old, undergoing elective adenotonsillectomy were included in the study. Children were randomly allocated to receive either a bolus of 3 mg kg intravenous tramadol or infiltration of the tonsillar lodge with 5-ml bupivacaine 0.25%. Reasons for exclusion were American Society of Anesthesiologists classification greater than 2, allergies to the investigated products, psychomotor retardation, bleeding disorders and lack of proficiency in Flemish. The primary endpoint was the number of children in need of piritramide postoperatively. Secondary outcomes included the cumulative dose of postoperative piritramide, pain scores and the incidence of postoperative nausea and vomiting during the first 24 postoperative hours, time to discharge and adverse effects. The proportion of children in need of postoperative piritramide was significantly lower in the tramadol group than in children with peritonsillar infiltration (57 vs. 81%, P < 0.001). When in need of postoperative piritramide, the tramadol-group required a significantly lower dose (median [IQR] 0.7 [0.6 to 1] vs. 1 [0.6 to 1.5] mg, P < 0.007) and had lower pain scores during the first 60 min after surgery. There were no statistically significant differences in postoperative nausea and vomiting incidence, need for antiemetics or complications. Compared with peritonsillar infiltration, preemptive intravenous tramadol decreases the need for postoperative opioids after tonsillectomy in children without increasing the incidence of side effects. EudraCT 2011-005467-25.
Sections du résumé
BACKGROUND
Adenotonsillectomy is a frequently performed procedure in paediatric day-case surgery. Postoperative pain can be significant and standard analgesia protocols are often insufficient.
OBJECTIVE
Our primary objective was to investigate if infiltration of the peritonsillar space with bupivacaine would reduce the need for postoperative opioids compared with pre-emptive intravenous tramadol.
DESIGN
A double-blind, randomised controlled trial.
SETTING
Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from January 2012 to September 2016.
PATIENTS
Two hundred children, between 4 and 10 years old, undergoing elective adenotonsillectomy were included in the study.
INTERVENTION
Children were randomly allocated to receive either a bolus of 3 mg kg intravenous tramadol or infiltration of the tonsillar lodge with 5-ml bupivacaine 0.25%. Reasons for exclusion were American Society of Anesthesiologists classification greater than 2, allergies to the investigated products, psychomotor retardation, bleeding disorders and lack of proficiency in Flemish.
MAIN OUTCOME MEASURES
The primary endpoint was the number of children in need of piritramide postoperatively. Secondary outcomes included the cumulative dose of postoperative piritramide, pain scores and the incidence of postoperative nausea and vomiting during the first 24 postoperative hours, time to discharge and adverse effects.
RESULTS
The proportion of children in need of postoperative piritramide was significantly lower in the tramadol group than in children with peritonsillar infiltration (57 vs. 81%, P < 0.001). When in need of postoperative piritramide, the tramadol-group required a significantly lower dose (median [IQR] 0.7 [0.6 to 1] vs. 1 [0.6 to 1.5] mg, P < 0.007) and had lower pain scores during the first 60 min after surgery. There were no statistically significant differences in postoperative nausea and vomiting incidence, need for antiemetics or complications.
CONCLUSION
Compared with peritonsillar infiltration, preemptive intravenous tramadol decreases the need for postoperative opioids after tonsillectomy in children without increasing the incidence of side effects.
TRIAL REGISTRATION
EudraCT 2011-005467-25.
Identifiants
pubmed: 30640245
doi: 10.1097/EJA.0000000000000950
doi:
Substances chimiques
Analgesics, Opioid
0
Anesthetics, Local
0
Pirinitramide
4RP92LYZ2F
Bupivacaine
Y8335394RO
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM