Patients In Bupivacaine Group Research Articles

Comparison between bupivacaine injection and mini-tenotomy in the management of horizontal small angle strabismus in children

ABSTRACT Purpose To compare the outcome of bupivacaine (BUP) injection vs mini-tenotomy of extra-ocular muscles in treating small angle horizontal strabismus in children. Methods A prospective comparative study that included a total of 40 patients. Twenty patients received 3 ml of 0.75% Bupivacaine (BUP) injection in both medial recti in case of exotropia and in both lateral recti in case of esotropia. MRI orbit was performed before and 30–60 days’ post injection of bupivacaine to estimate changes in muscle size. Mini-tenotomy was done in the other 20 patients, performed on both lateral recti in case of exotropia and on both medial recti in case of esotropia. Results Mean change of alignment at the end of 6 months in exotropic patients in bupivacaine group was 5.50 ± 4.10 PD and in esotropia patients 4.00 ± 3.38 PD with an average increase in muscle thickness of 0.12 mm ± 0.08 and 0.13 mm ± 0.09 in exotropia and esotropia, respectively. There was an average increase in volume 23 mm3 ± 17.3 and 17.00 mm3 ± 9.50 in exotropia and esotropia, respectively, as measured with MRI. The mean change of alignment in mini-tenotomy was 5.33 ± 4.12 PD, 5.75 ± 4.95 PD in exotropia and esotropia, respectively. Conclusion Bupivacaine and mini-tenotomy are safe and effective alternative treatment, that improved eye alignment in 65% of patients with small angle horizontal deviation.

Comparison of Intra-Peritoneal Bupivacaine with Saline Solution after Laparoscopic Cholecystectomy

Objective: To compare the mean pain score of intra-peritoneal bupivacaine versus saline solution in patients undergoing laparoscopic cholecystectomy for cholelithiasis. Material and methods: Between April 2021 to October 2021, total 100 diagnosed patients of cholelithiasis having age 18-70 years, of either gender planned to undergo laparoscopic cholecystectomy under general anesthesia with ASA I-II were selected from Department of Surgery, Mayo Hospital, Lahore. In Bupivacaine group, Intra-peritoneal Bupivacaine was given. In Saline group, Intra-peritoneal Saline Solution was given. Laparoscopic Cholecystectomy was performed. Mean pain score was compared between Bupivacaine group and Saline group. Results: Patients having age 18-70 years were selected. Mean age was 43.80±15.60 years. The mean age of patients in Bupivacaine group was 43.3±16.0 years and in Saline group was 44.3±15.3 years. In Bupivacaine group and Saline group, mean pain score was 1.82±0.75 and 4.72±1.20 respectively. Significantly (P=0.000) low mean pain score was noted in Bupivacaine group as compared to Saline group. Conclusion: There is a significant difference in mean pain score of intra-peritoneal bupivacaine versus saline solution in patients undergoing laparoscopic cholecystectomy for cholelithiasis. Keywords: Cholelithiasis, Cholecystectomy, Intra-peritoneal Bupivacaine, Saline Solution.

Comparison of the effectiveness of Ropivacaine soaked vs bupivacaine soaked dressing for pain relief at split thickness skin graft donor site.

Objectives: To compare the mean pain score of ropivacaine soaked dressing versus bupivacaine-soaked dressing for pain relief at the donor site among patients requiring split thickness skin grafting after burns and tissue loss. Study Design: (RCT) Randomized control trial. Setting: Department of Plastic Surgery Jinnah Burn and Reconstructive Surgery Center Lahore. Period: January 1, 2019 to June 31, 2019. Material & Methods: Total 120 patients meeting the inclusion criteria were enrolled and divided randomly into Group-A and Group-B based on lottery method. Group A was dressed with ropivacaine soaked dressing while group-B with bupivacaine-soaked dressing. Patients were asked about pain four hours after the dressing using the verbal rating scale of 0-10. Result: Total 120 patients were included and randomly divided in to two groups. The mean age of ropivacaine group (Group A) patients was 40.82±13.20 years and bupivacaine group (Group-B) patients was 39.70±12.20 years. 56(46.67%) patients were males and 64(53.33%) patients were females. Male to female ratio was 0.8:1. The mean size of the defect for Group-A patients was 10.43±2.92 and Group B patients was 10.13±2.91. The Mean Visual Rating Scale (VRS) at the baseline for ropivacaine was 7.95 ± 1.04 and for bupivacaine was 8.0167 ±.791 (p =0.695) and VRS (verbal rating scale) at 4 hours of ropivacaine group patients was 1.27±1.13 and in bupivacaine group patients was 2.58±1.61. The statistically significant difference is found between the two study groups for VRS at 4 hours (p-value=0.001). Conclusion: Ropivacaine soaked dressing showed significantly better outcome than bupivacaine-soaked dressing at the donor site among patients requiring split thickness skin grafting after burns and tissue loss.

Efficacy of liposomal bupivacaine versus bupivacaine in port site injections on postoperative pain within enhanced recovery after bariatric surgery program: a randomized clinical trial

BackgroundUse of liposomal bupivacaine (LB) in surgery is reported with decreased postoperative opioid requirements. The efficacy of LB versus standard bupivacaine injections at laparoscopic port sites during bariatric surgery is unknown. ObjectivesTo determine whether there was a difference in postoperative hospital opioid requirements after port site injections of LB versus standard bupivacaine during laparoscopic bariatric surgeries. Primary endpoint was total in hospital opioid use expressed as morphine-equivalent use. Secondary endpoints included home opioid use, pain scores, hospital length of stay, and adverse events. SettingAcademic-affiliated private practice. MethodsA 2-group randomized, double-blinded trial from November 2017 to August 2018 with patients randomly assigned to receive either LB or bupivacaine alone at trocar site injections during laparoscopic Roux-en-Y gastric bypass (LRYGB) or vertical sleeve gastrectomy (VSG). All patients underwent enhanced recovery after bariatric surgery protocols. ResultsAll patients undergoing LRYGB or VSG assessed for eligibility. Of 682 patients undergoing LRYGB or VSG, 231 met inclusion criteria, 52 patients excluded intraoperatively. Among 231 patients (mean age, 39.2 years; 79% women; mean body mass index 45.0), 179 patients (77%) completed the trial. Patients randomly assigned to receive either LB (n = 89) or bupivacaine alone (n = 90) at trocar site injection during LRYGB or VSG. Postoperative morphine-equivalent use were similar (LB 8.3 [standard deviation 4.0–13.9] versus bupivacaine group 7.5 [standard deviation 3.6–13.1] P = .94) with highest requirement in first 4 hours after surgery. There was no significant difference in length of stay, pain scores, or complications. There were more patients in the bupivacaine group that did not take pain medications on postoperative days 2 to 4 (P = .032, P = .23, P = .005, respectively). There were more patients in the bupivacaine group 48.1% (n = 39) compared with the LB group 34.2% (n = 27) that did not consume any narcotic tablets at home but this not found to be statistically significant (P value = .07). ConclusionsAmong patients undergoing primary bariatric surgery under enhanced recovery after bariatric surgery protocol, there was no significant difference in postoperative hospital opioid use in those receiving LB compared with standard bupivacaine. A greater percentage of patients in the standard bupivacaine group did not require any narcotics at home, which was significant on postoperative days 2 to 4. To become completely opioid free after bariatric surgery, resources should be focused on multimodal approaches instead of reliance on type of anesthetic medication used.

Compare the efficacy of ropivacaine and bupivacaine with fentanyl for epidural labor analgesia

Background: Attempts have been made to reduce or eliminate the pain associated with labor since ancient time. Obstetrics analgesia reached a new phase with lumbar epidural analgesia. We carried out a randomized study to evaluate and compare the analgesic efficacy of ropivacaine and bupivacaine with fentanyl on mother, on fetus and on the course of labor. Objectives: The aim of the present study was to evaluate and compare the analgesic efficacy of ropivacaine (0.125%) and bupivacaine (0.125%) with fentanyl on mother, fetus and on the course of labor, incidence of instrumental delivery, and the rate of cesarean section. Materials and Methods: Study was conducted in 60 term, primi or second gravida parturients with active phase of labor, with cervical dilatation 3-5 cm, with single fetus, vertex presentation belonging to American Society of Anesthesiology (ASA) Class I or II. The patients were randomly divided into two groups. After negative test dose, loading dose of 10 ml of 0.125% ropivacaine in Group R and 0.125% of bupivacaine in Group B with 2.5 μg/ml fentanyl in both groups was given as an initial dose for analgesia. Top up dose with 5 ml of 0.125% of ropivacaine in Group R and 0.125% bupivacaine in Group B were given when visual analog scale (VAS ≥3). For the second stage of labor 8 ml of 0.125% of ropivacaine in Group R and 0.125% of bupivacaine in Group B with 1.25 μg/ml fentanyl in both groups were given in sitting position to allow perineal analgesia. Results: In this study, we observed that maximum number of patients have developed sensory block up to T8, 50% in Group B and 53.3% in Group R, only 2 patients (6.7%) in Group B developed T6 level, and no patients in Group R. There was no significant difference in mean total dose of bupivacaine and ropivacaine (P > 0.05). In Group R total 22 patients and 3 in Group B developed Grade 0 motor blocked, which was statistically very significant. In Group B, 14 and 2 patients developed Grade 2 and Grade 3 motor blocked, respectively, compared to none of the patients in Group R which was statistically very significant. There was no significant difference in Apgar score and VAS scores between the groups at any time during the first and second stage of labor. Conclusions: Ropivacaine group patients required less number of top-up doses and developed significantly less motor block than bupivacaine group patients. We thus conclude that the combinations of 0.125% of ropivacaine with fentanyl and 0.125% bupivacaine with fentanyl is equally effective in producing excellent labor analgesia ensuring the safety of the mother and fetus.

Combined Intrathecal Morphine and Dexmedetomidine for Postoperative Analgesia in Patients Undergoing Major Abdominal Cancer Surgery.

To compare the analgesic effect of combined intrathecal morphine and dexmedetomidine with either drug alone for postoperative analgesia in patients undergoing major abdominal cancer surgery. Ninety patients were allocated to receive intrathecal 10 mg bupivacaine 0.5% (bupivacaine group, n = 30), 10 mg bupivacaine 0.5% and 0.5 mg morphine (Morphine Group, n = 30), or 10 mg bupivacaine 0.5%, 0.5 mg morphine and 5 µg dexmedetomidine (morphine-Dex group, n = 30). The groups were compared with time to first postoperative analgesia, iv patient-controlled analgesia (PCA) morphine consumption, pain scores, hemodynamics, sedation, and adverse events in the first 48h postoperative. The time to first use of morphine PCA was longer in morphine (22.13 ± 5.21h, P = 0.000) and morphine-Dex (23.46 ± 4.69h, P = 0.000) groups compared with bupivacaine group (0.50 ± 0.09h). Dexmedetomidine addition increased the duration of intrathecal morphine (ITM) analgesia by 1.33 h (P = 0.485). Morphine consumption was less in morphine (10.83 ± 2.96 mg, P = 0.000) and morphine-Dex (11.00 ± 3.32 mg, P = 0.000) groups than in bupivacaine group (27.5 ± 4.30 mg), with a nonsignificant difference between morphine and morphine-Dex groups (P = 0.375). Morphine and morphine-Dex groups showed lower pain scores (P < 0.001). Intraoperative blood pressure and heart rate were lower in morphine and morphine-Dex groups (P < 0.05) with no significant difference between groups in postoperative hemodynamics. Patients in bupivacaine group showed a higher incidence of postoperative nausea (P < 0.03) and vomiting (P < 0.01), while patients in morphine and morphine-Dex groups had a higher incidence of pruritus (P < 0.02). Our results do not support improved analgesia with the combination of intrathecal morphine and dexmedetomidine, despite the absence of significant adverse effects.

Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia.

Background:There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges.Aim of the Study:The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness.Patients and Methods:Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA.Results:Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group P < 0.001 and P < 0.01 respectively. The upper dermatomal height of sensory block reached was T9 and T8 in groups B and L respectively. Group B showed more intense motor block than group L. There was no significant difference between both groups as regards postoperative side effects P > 0.05. Group L patients did not stay in PACU, and all patients bypassed it P < 0.001. Bupivacaine group patients showed significantly longer time to ambulate and time to home-readiness than lidocaine group P < 0.001 and P < 0.01 respectively.Conclusion:Both techniques of SSA were clinically efficient as subarachnoid block, and they had less postoperative side effects. Lidocaine spinal was more eligible for fast-tracking anesthesia than bupivacaine spinal with shorter time to ambulate and home-readiness time.

English

BACKGROUND: Various adjuvants are being used with local anaesthetics in spinal anaesthesia for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine, a highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. AIMS: To evaluate the onset and duration of sensory and motor block, hemodynamic effect, post-operative analgesia and adverse effects of dexmedetomidine given intrathecally with hyperbaric 0.5% bupivacaine. METHODOLOGY: A study was carried out in 30 adult female patients aged 18-55 yrs of ASA grade I and II in each group scheduled for Total abdominal hysterectomy under spinal anaesthesia. Group B received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml of normal saline. Group D received 2.5ml of 0.5% hyperbaric bupivacaine with 10µg of dexmedetomidine in 0.5ml of normal saline. The onset time to reach peak sensory and motor level, regression time of sensory and motor block, rescue analgesia, hemodynamic changes and side effects were recorded. STATISTICAL ANALYSIS USED: Data obtained were tabulated and analyzed using statistical package for social science (SPSS 16.0 evaluation version) to calculate the sample size. Descriptive data are presented as Mean ± SD and Continuous data are analyzed by unpaired't' test. P<0.05 was considered statistically significant. RESULTS: Patients in dexmedetomidine group (group D) had a significantly longer sensory and motor block than patients in bupivacaine group (group B). The mean time of sensory regression to S1 was (323 ± 31 min) in group D and (191 ± 15min) in group B. The regression time of motor block to reach Bromage 0 was (314 ± 30 min) in group D and (163 ± 15 min) in group B. The time to rescue analgesia was significantly longer in group D (383 ± 38 min) as compared to group B (228.6 ± 15 min). CONCLUSION: Intrathecal dexmedetomidine as adjuvant to spinal bupivacaine is associated with prolonged sensory and motor block, hemodynamic stability and reduced demand of rescue analgesia in twenty four hours.

A comparative evaluation of hyperbaric ropivacaine versus hyperbaric bupivacaine for elective surgery under spinal anesthesia.

Background:Recently introduced ropivacaine is 40% less potent than bupivacaine. Ropivacaine made hyperbaric by the addition of dextrose is known to provide reliable spinal anesthesia (SA). This study was designed to compare the clinical efficacy of equal doses of hyperbaric 0.5% ropivacaine with 0.5% bupivacaine for SA.Materials and Methods:Eighty American Society of Anesthesiologists grade I-II patients undergoing elective infraumbilical surgeries under SA were recruited and randomized to receive 3ml of hyperbaric ropivacaine 5mg/ml containing dextrose 83 mg/ml (by the addition of desired dose of 25% dextrose) in Group R or 3ml of hyperbaric bupivacaine 5mg/ml containing dextrose 80 mg/ml in Group B. Monitoring of vitals and observation for the block parameters were carried out. The data were presented as mean with a standard deviation and frequency with percentage. Statistical analysis was performed using InStat computer software with appropriate tests and P < 0.05 was considered to be significant.Results:Ropivacaine produced a slower onset of sensory block (ropivacaine 4.5 min; bupivacaine 3.2 min; P < 0.05) and the mean total duration of sensory block was significantly lesser (ropivacaine155 min; bupivacaine 190.5 min; P < 0.05). Patients in the ropivacaine Group R had significantly more rapid recovery from the motor blockade (ropivacaine120 min; bupivacaine 190 min; P < 0.05) and passed urine sooner than the patients in bupivacaine Group B (ropivacaine 257 min; bupivacaine 358 min; P < 0.05).Conclusion:Ropivacaine 15 mg in dextrose 8.3% provides reliable SA of shorter duration than bupivacaine 15 mg in 8% dextrose.

Effect of long acting local anesthetic on postoperative pain in teeth with irreversible pulpitis: Randomized clinical trial

ObjectiveThe objective of this study was to compare the effect of long acting anesthetics on postoperative pain in teeth with irreversible pulpitis. MethodologyForty patients were randomly assigned into two groups of twenty patients each. Each patient who fit the inclusion criteria was administered local anesthesia before undergoing root canal treatment. The anesthetic solution was either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine. Patients were instructed to complete a VAS pain score at 6, 12, 24h after single visit root canal treatment. Data were analyzed by Mann–Whitney, Cochrane Q analysis and t test to compare qualitative and quantitative data between the groups. ResultsThe results showed the levels of pain of the patients who received lidocaine as the anesthetic agent and had significantly more postoperative pain after root canal treatment (P<0.05) but had significantly decreased pain by 24h compared to the bupivacaine group patients who had significantly lower postoperative pain levels at 6 and 12h. ConclusionThe use of long acting local anesthetic can significantly reduce the postoperative pain in teeth with irreversible pulpitis.

Levobupivacaína versus bupivacaína em anestesia peridural para cesarianas: estudo comparativo

JUSTIFICATIVA E OBJETIVOS: O anestésico local bupivacaína é encontrado na forma de dois enantiômeros: levobupivacaína - S (-) e dextrobupivacaína - R (+). Baseado em estudos que demonstram que a cardiotoxicidade é menor com o enantiômero S(-), foi difundido o uso deste agente na prática clínica. Este estudo teve por objetivo comparar a eficácia e a efetividade do uso de bupivacaína racêmica com levobupivacaína em anestesia peridural de pacientes submetidas à cesariana eletiva. MÉTODO: Ensaio clínico aleatório, duplamente encoberto, com gestantes estado físico ASA I e II. As pacientes foram alocadas para receber 20 mL de bupivacaína a 0,5% racêmica ou 20 mL de levobupivacaína a 0,5%, ambas com 10 µg de sufentanil e vasoconstritor. RESULTADOS: Participaram do estudo 47 pacientes, 24 no grupo da levobupivacaína e 23 no grupo da bupivacaína. Os grupos eram comparáveis entre si quanto às características materno-fetais. Decorridos 15 minutos após o término da punção peridural, 62,5% das pacientes do grupo da levobupivacaína tinham Bromage 2 ou 3 versus 72,7% no grupo da bupivacaína (p = 0,83). Aos 20 minutos, 66,7% das pacientes do grupo da levobupivacaína tinham Bromage 2 ou 3 versus 86,3% do grupo da bupivacaína (p = 0,21). A complicação mais freqüente foi a hipotensão arterial, encontrada em 16 (66,7%) pacientes do grupo da levobupivacaína e em 10 (43,5%) pacientes do grupo da bupivacaína (p = 0,11). CONCLUSÕES: A levobupivacaína e a bupivacaína foram igualmente efetivas no bloqueio peridural de pacientes submetidas à cesariana.

The effectiveness of an anesthetic continuous-infusion device on postoperative pain control

Purpose: To evaluate the effectiveness of an anesthetic continuous-infusion device on postoperative pain after outpatient shoulder surgery. Type of Study: Double-blinded randomized trial. Methods: A prospective, double-blinded, randomized study of 50 consecutive patients undergoing outpatient arthroscopic shoulder surgery was performed. Patients were assigned by computer-generated randomized permuted block of four to 2 groups (25 each) receiving either a saline or 0.5% bupivacaine solution via an infusion pump after surgery. All patients gave informed consent and were randomized immediately before surgery. The surgical team, patient, clinic staff, and data collector were blinded to the randomization. Procedures performed included arthroscopic rotator cuff repairs, SLAP lesion repairs, subacromial decompressions, and capsular reefings. The infusion pump that was tested was used continuously for 48 hours and administered 2 mL each hour. For subacromial and rotator cuff surgery, the catheter was placed in the subacromial space. For glenohumeral surgery, the catheter was placed in the glenohumeral joint. Routine pain-control efforts were continued. Interviews were conducted at 1, 2, and 8 hours after surgery, followed by daily telephone interviews for 1 week. Visual analog scale (VAS), categorical pain scale (Likert) data, and oral medication use data were recorded. Results: Complete data sets were collected from 25 bupivacaine and 24 saline patients because 1 pump malfunctioned and was removed early. The average age of the bupivacaine group patients was 47.4 ± 16.3 years (range, 16 to 84); patients in the saline group had an average age of 46.0 ± 15.5 years (range, 19 to 73). There were 17 men and 8 women in the bupivacaine group and 16 men and 8 women in the saline group. The Likert and VAS mean values showed lower pain scores for the patients using the pump containing bupivacaine than for the saline group at all recorded times ( P < .05) throughout the 7 days of data collection. The interval of greatest pain was on day 2. Postoperative oral medication use was always greater for the saline group than for those receiving bupivacaine. Conclusions: Postoperative pain control after arthroscopic shoulder surgery is essential so that these procedures can be successfully carried out in an outpatient setting. The first 2 postoperative days is the period of greatest pain. Continuous postoperative bupivacaine infusion is effective during this critical period, and the effect lingers even after the infusion is discontinued. The administration of bupivacaine via a continuous-infusion anesthetic pump statistically reduced postoperative pain after outpatient arthroscopic rotator cuff repairs, SLAP lesion repairs, subacromial decompressions, and capsular reefings.

The comparison of the intrathecal pethidine with intrathecal bupivacaine in transurethral resection of prostate

The aim of this study is to compare the haemo- dynamic effects, and possible complications of intra- thecal pethidine with intrathecal bupivacaine in transurethral resection of prostate (TURP) in benign prostatic hyperplasia. Forty patients in ASA il risk group were allocated randomly to one of two groups; in Group 1 (n=20) patients, spinal anaesthesia was applied by administration of intrathecal 12.5 mg bupivacaine, and in Group il (n::20) patients by 0.75 mg/kg 5 % pethidine. The time for sensorial and motor block was studied. Complications were noted. Duration of sensorial blockade was longer in bupivacaine group than in pethidine group (171 min, and 84. 7 min respectively). The time for completion of regression of block to fıfth lumbar dermatom (353.5 min, and 145.5 min. respectively) and the time for regression of all motor function (348.5 min, and 101.25 min respectively) was longer in bupivacaine group than pethidine group, which was statistically signifıcant (p&lt;0.05). There was no statistically signifıcant difference in heart rate (HR) and mean arterial pressure (MAP) between two groups. There was a decrease in HR and MAP within groups but was not statistically signifıcant. Respiratory depression was not seen in any patient, and oxygen saturation of arterial pulse did not decrease under 95%. Nausea was observed in 3 patients in bupivacaine group, and 5 patients in pethidine group. Ephedrine was needed in 2 patients in pethidine group. Pruritus was not seen in bupivacaine group, but in 3 patients in pethidine group. Midazolam, totally 2 mg. to each patient, was given to 3 patients in bupivacaine group, and 4 in pethidine group,. Atropin was given to 4 patients in bupivacaine group and 5 patients in pethidine group. Drowsiness was seen only in 1 patient in pethidine group. As a result, it is concluded that intrathecal pethidine can be used as bupivacaine in TURP operations, and this cheaper technique can be an alternative in allergic patients to loca! anaesthetics.

Control of Early Postoperative Pain with Bupivacaine in Pediatric Tonsillectomy

Early postoperative pain following pediatric tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and occasionally requires overnight hospitalization in same day surgery practices. Several otolaryngologists anecdotally support intraoperative infiltration with a long-acting amide anesthetic, bupivacaine hydrochloride, for postoperative pain control. However, no previous study supports these claims. At the National Naval Medical Center, a prospective, randomized, double-blinded study was undertaken in fifty patients, ages 3 to 16 years old. After tonsil resection, either 0.5% bupivacaine or saline was injected into each fossa. We asked the parents three questions. First, what was the level of pain at 2, 6 and 10 hours postoperatively? Second, what was the amount of oral intake during the first 10 hours after surgery? And third, how many doses of oral acetaminophen elixir were administered over the first 10 postoperative hours? Bupivacaine administration caused no adverse effects. There was no difference in perceived pain level between bupivacaine and saline groups at 2, 6 and 10 hours. Oral intake levels over the first 10 hours were similar. Although bupivacaine group patients received fewer doses of oral acetaminophen, the difference between groups was not statistically significant. We conclude that bupivacaine is a safe medication for infiltration, but offers no advantage over saline in the control of early postoperative pain in pediatric tonsillectomy.

Control of Early Postoperative Pain With Bupivacaine in Adult Local Tonsillectomy

Early postoperative pain following tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and occasionally requires overnight hospitalization in same-day surgery practices. Although several otolaryngologists anecdotally support intraoperative infiltration with long-acting anesthetic agents for postoperative pain control, to our knowledge, no previous study confirms this claim. In a prior investigation, we found no difference between bupivacaine hydrochloride and saline placebo in pediatric patients undergoing tonsillectomy. In this trial, we performed a similar study in an adult population. Fifty-one patients undergoing tonsillectomy with local anesthesia were randomized into bupivacaine or saline placebo groups. Patients provided the following data: (1) pain level; (2) oral intake; (3) number of pain medication doses; and (4) level of pain on jaw opening, all at 10 hours postoperatively. Bupivacaine administration resulted in no adverse effects. No difference was noted in pain level, amount of oral intake, or pain on full jaw opening. Bupivacaine group patients received fewer though not statistically significant doses of pain medication than placebo group patients. We conclude that bupivacaine is a safe medication but offers no advantage in the control of early postoperative pain in adult patients undergoing local tonsillectomy.