Comparative study between pre-emptive transcutaneous versus transoral ultrasound-guided peritonsillar space infiltration with bupivacaine during elective tonsillectomy

Abstract

Background Ultrasound (US) as a technique is safe, readily available, quick, and portable allowing more accuracy of different regional blocks and local infiltration. It allows imaging of the mouth, oropharynx, infrahyoid structures, larynx, vocal cords, and the trachea. Recently, point-of-care US has been shown to improve accuracy in US-guided block with local anesthetic infiltration. Objective The objective of the study was to compare the effect of pre-emptive transoral US-guided peritonsillar infiltration versus transcutaneous US-guided peritonsillar infiltration with bupivacaine for post-tonsillectomy analgesia on surgical field, and surgeon satisfaction (intraoperative reactionary bleeding). Study design A clinical, prospective study. Patients and methods Sixty patients (25 men, 35 women) were admitted for tonsillectomy at the ENT Department of the Al-Azhar and Ain Shams University Hospitals. The age of the patients ranged from 3 to 15 years. The patients were divided into cutaneous group consisting of 30 patients who were submitted to transcutaneous US-guided peritonsillar infiltration with bupivacaine and the oral group consisting of 30 patients who were submitted to transoral US-guided peritonsillar infiltration with bupivacaine. Results The study showed no statistically significant difference between the two studied groups regarding age, sex, and weight with P values of 0.602, 0.190, and 0.164, respectively. The oral group was significantly shorter as regards the time needed to detect peritonsillar space and the time needed to perform peritonsillar infiltration with a P value of 0.000. The cutaneous group gave significantly better results as regards direct surgeon satisfaction questionnaire about bleeding and surgical field, weighing amount of soaked gauze with blood per tonsil, dissection time, and the amount of blood suctioned with P value 0.118, 0.318, 0.851, and 0.112, respectively. Conclusion Peritonsillar space can be infiltrated equally and safely using transcutaneous US or transoral US and may be considered as an alternative technique to traditional blind technique when performed by an experienced team.