Effect on postoperative pain after local application of bupivacaine in the tonsillar fossa; a prospective single blind controlled trial.

OBJECTIVE To assess the effect on postoperative pain after local application of bupivacaine in the tonsillar fossa. METHODS Seventy two patients were recruited in this prospective single blind controlled trial. There were 45 females and 27 males between the ages of 7 and 35 years. After tonsillectomy the right tonsillar fossae (subject fossae) were packed with tonsillar gauze soaked in 2 mls of 0.5% Abbocaine (bupivacaine) solution and kept in situ for five minutes. The left fossae (control fossae) were packed with the similar tonsillar swab soaked in 0.9% normal saline. RESULTS The main outcome measure was severity of pain by using visual analogue score. The measurements were taken at various intervals, i.e. after 4 hours, before bed, before breakfast, before lunch and before discharge. The mean post-operative pain scores for the subject fossa after 4 hours, before bed, before breakfast, before lunch and before discharge were 3.09 (+/- 0.85), 3.25 (+/- 0.64), 2.89 (+/- 0.72), 2.47 (+/- 0.67) and 2.37 (+/- 0.57) respectively. The mean post-operative pain scores for control fossa after 4 hours, before bed, before breakfast, before lunch and before discharge were 5.78 (+/- 1.51), 5.50 (+/- 1.29), 4.34 (+/- 1.13), 3.29 (+/- 0.91) and 2.73 (+/- 0.81) respectively. There was significant difference between subject and control fossae scores at all the stages up to discharge of patients, showing better pain relief with bupivacaine. CONCLUSION Topical application of bupivacaine to the tonsillar fossa can reduce post-operative pain and facilitate early eating and drinking during the post-operative period.