Bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children: A meta-analysis

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Abstract

Objective

A meta-analysis was performed to explore the role of peri-operative bupivacaine infiltration in the relief of pain in adenotonsillectomy.

Methods

Data from Medline, EMBase, Springer and the Cochrane Collaboration database were searched. Reference lists from identified publications were scanned. RevMan 5.0 software was used for statistical analysis.

Results

7 random controlled tests (a total of 286 cases) were included. Pain intensity was evaluated by VAS score or Cheops score. The pain of group bupivacaine (Group B) was less severe than group placebo (Group P). Analgesic requirement of Group B was less than Group P. Nevertheless the difference of complication between bupivacaine and placebo had no statistical difference.

Conclusion

Bupivacaine infiltration is a safe and effective method for relief of pediatric post-adenotonsillectomy pain.

Introduction

Patients receiving adenotonsillectomy have a high incidence of postoperative pain which has become an important part of postoperative management. Children often refuse analgesics just because the pain caused by the injection of medicine. Sometimes local anesthetics are administered to the tonsillar region, but the effectiveness in relieving pain and safety has not been formally assessed [1]. This paper focuses on analyzing local anesthesia with bupivacaine in all available random controlled trials which undergoing adenotonsillectomy in children, in hope of assessing its safety and clinical therapeutic effect, in order to provide evidence for its appropriate clinical use in treatment.

Section snippets

Patient and methods

The Medline, the Cochrane Collaboration database, EMBase were used as major databases and the literature search was performed for articles entered from 1990 to September 2009; Search key words from MESH index included ‘bupivacaine’, ‘local anesthesia’ and combined with the words ‘adenotonsillectomy’, ‘tonsillectomy’, and ‘adenoidectomy’. The languages were not restricted.

We restricted our review to random controlled trials and general anesthesia. Thus, the references, which satisfy the

Results

Our search identified 7 prospective randomized controlled clinical trials of bupivacaine versus normal saline for relief of post-adenotonsillectomy pain in children [2], [3], [4], [5], [6], [7], [8]. The characteristic and quality analysis of selected reference were respectively summarized in Table 1, Table 2.

The results of tests for heterogeneity revealed homogeneity in these studies (p = 0.69); therefore, we adopted a fixed-effect model to perform combined analysis. 4 references [2], [3], [4],

Discussion

Adenotonsillectomy is usually associated with severe postoperative pain that may result in poor oral intake in children. It has been suggested that the pain is caused by inflammation, irritation of the pharyngeal musculature. Injection of a local anesthetic agent is believed to decrease pain by producing pharmacologic blockade of the sensory pathways and prevent the nociceptive impulses from reaching the spinal cord, thus decrease the occurrence of complication, such as postoperative bleeding

Conclusions

In conclusion, bupivacaine infiltration is a safe and effective method for pediatric post-adenotonsillectomy pain. Funnel plots of the trials have not showed obvious bias in publications. The trials identified are of small size and the quality of them is low, which could affect the reliability of the conclusions. Further randomized controlled trials are necessary.

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  • Anesthetic injections and analgesia use in pediatric post-tonsillectomy patients: A meta-analysis and systematic review

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    Unfortunately, we were unable to stratify our data by age, as we did not have access to complete data sets. Our findings support and expand upon previous studies findings of decreased pain with anesthetic injection [3]. Current guidelines recommend using ibuprofen and acetaminophen for pain postoperatively, and anesthetic injection may play a key role in facilitating this [1].

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