Preoperative peritonsillar infiltration of dexamethasone and levobupivacaine reduces pediatric post-tonsillectomy pain: a double-blind prospective randomized clinical trial.

Background: Preoperative corticosteroids reduce post-tonsillectomy morbidities. The present study was performed to compare the effect of peritonsillar dexamethasone infiltration to intravenous injection together with peritonsillar levobupivacaine infiltration before tonsillectomy on postoperative pain in children.

Methods: One hundred twenty children, ASA I-II, aged 6-12 years, scheduled for adenotonsillectomy were enrolled in the study. They were randomized equally into two equal groups; 60 children each. Group A received peritonsillar infiltration with dexamethasone and levobupivacaine, and group B received i.v. dexamethasone and peritonsillar levobupivacaine infiltration. Rest and swallowing pain in the first postoperative day using a visual analogue scale, time to first rescue analgesia, cumulative paracetamol dose, vomiting, and adverse effects related to both interventions during the first postoperative day were recorded. Children care givers were asked to score pain using a verbal rating scale and to disclose complications as halitosis, headache, fever and otalgia during the first postoperative week.

Results: Time to first rescue analgesia was significantly longer in group A. Rest and swallowing pain in the first postoperative day, cumulative paracetamol dose, pain in the second and third postoperative days, and otalgia were significantly lower in group A. None of children developed postoperative bleeding, or complications related to dexamethasone or levobupivacaine infiltration. There was no significant difference in postoperative emesis, fever and halitosis between the groups.

Conclusions: Addition of dexamethasone to levobupivacaine for preoperative peritonsillar infiltration has better postoperative analgesic effects than i.v. dexamethasone combined with peritonsillar levobupivacaine infiltration in children.