Objectives: To evaluate postoperative (PO) analgesic efficacy of pre-incisional peritonsillar infiltration (PI) using tramadol alone or in combination with bupivacaine in adults assigned for tonsillectomy. Patients & Methods: Eighty patients were allocated into four equal groups: Control group received saline, Bupivacaine group received bupivacaine (5 mg/ml), Tramadol group received tramadol (2 mg/kg b.wt.) and Combination group received combination of bupivacaine and tramadol. All medications were injected as 1 ml per tonsil 3 min prior to incision (pre-incisional). Evaluated parameters included duration of PO analgesia and PACU stay and total hospital stay. Postoperative pain sensation was evaluated using 10-points visual analogue scale (VAS) score and rescue analgesia (morphine 0.05 mg/kg i.v.) was administered at VAS score ≥4. Patients were asked to rate their satisfaction with analgesia on a 7-point scale. Results: All patients had smooth intraoperative within mean operative time of 62±4.9 minutes and mean intraoperative blood loss of 41.7±4.7 ml. Collective VAS pain scores were significantly higher in control group compared to other groups, while combination therapy provided significantly lower pain scores compared to tramadol alone or bupivacaine alone. Twenty-five patients were discharged without requesting rescue analgesia. Combination therapy provided better PO analgesia lasting for longer duration with significant difference compared to other groups. Duration of hospital stay was significantly shorter in patients received infiltration therapy compared to control group with significantly shorter duration with combination therapy. Patients received infiltration therapy were significantly satisfied compared to control group with significantly higher satisfaction scores in combination and tramadol groups compared to bupivacaine alone. Conclusion: Pre-incisional peritonsillar infiltration is a safe and effective analgesic modality for post-tonsillectomy pain in adults and combined bupivacaine and tramadol infiltration is the appropriate for achieving superior postoperative analgesia. |
