Comparative efficacy of topical lidocaine, tetracaine, and articaine for post-tonsillectomy pain management in children: a prospective, placebo-controlled study

Abstract

Background

The most important problem in tonsillectomy is pain in the early postoperative period.

Objective

We purposed to compare the effects of lidocaine, tetracaine, and articaine application to the peritonsillar bed on post-tonsillectomy pain in children.

Methods

The prospective, placebo-controlled study included 80 patients, ages 3–14, who were scheduled for elective tonsillectomy. Patients were randomly divided into four groups. Group 1 received 0.9% NaCl; group 2 received 2% lidocaine; group 3 received 2% tetracaine; and group 4 received 4% articaine to the tonsillary bed for 5 min just after the operation. All patients were evaluated in terms of pain and pain-related adverse events in the postoperative 24 h.

Results

All groups that used local anesthetics had significantly lower pain levels than the control group in the first eight hours (p < .001). Furthermore, the articaine group had a lower pain score than the tetracaine group at the eighth hour (p < .05). The articaine group had a lower pain score at the 16th hour than both the control and tetracaine groups (p < .05). There was no significant difference between the groups at the 24th hour (p > .05).

Conclusion and significance

We recommend the immediate application of topical articaine to the tonsillar bed following the procedure to enhance postoperative pain management.

Chinese Abstract

背景

扁桃体切除术中最重要的问题是术后早期疼痛。

目的

比较将利多卡因、丁卡因和阿替卡因施用于扁桃体围部对儿童扁桃体切除术后疼痛的影响。

方法

这项前瞻性、安慰剂对照研究纳入 80 名年龄在 3-14 岁之间、计划进行选择性扁桃体切除术的患者。患者被随机分为四组。在手术后 5 分钟内, 将不同试剂施用于扁桃体床。第 1 组接受 0.9% NaCl；第 2 组接受 2% 利多卡因；第 3 组接受 2% 丁卡因；第 4 组接受 4% 阿替卡因。对所有患者在术后 24 小时内的疼痛和疼痛相关不良事件进行了评估。

结果

所有使用局部麻醉剂的组的疼痛水平在前 8 小时内都明显低于对照组的疼痛水平(p < .001)。此外, 阿替卡因组在第 8 小时的疼痛评分低于丁卡因组 (p < .05)。阿替卡因组在第 16 小时的疼痛评分低于对照组和丁卡因组 (p < .05)。第 24 小时组与组之间没有显著差异 (p > .05)。

结论和意义

我们建议在手术后立即将局部阿替卡因施用于扁桃体床, 以加强术后疼痛管理。

Keywords:

• Analgesia
• children
• local anaesthetic
• pain
• tonsillectomy

Author contributions

Vahit Mutlu: study conception, design, material preparation, data collection, analysis, and writing of first draft. Zulkuf Kaya: analysis, material preparation, and approving of final manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent form

Informed consent was obtained from all individual participants included in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

No funding was received for this research.