Main Article Content

Muhammad Ismail Khan
syed fahim shah
Muhammad ,
Kamran Iqbal


Objective: To determine the relief of pain after tonsillectomy by application of topical 0.5% bupivacaine.

Methodology: This prospective single-blind study was conducted at Departments of ENT, Mufti Mehmood MemorialTeaching Hospital and District Headquarter Teaching Hospital, Dera Ismail Khan from January 2011 to June 2012. Subjectsof either sex, aging 10-35 years with history of recurrent episodes of acute tonsillitis were included. Those withadenotonsillectomy, with history of acute tonsillitis within three weeks, bleeding diathesis, suspicious of malignancy,or hypersensitivity to bupivacaine were excluded. Subjects were divided into group 1 (treatment group) and 2 (controlgroup) of 48 patients each on convenient sampling method. Patients in group 1 received a topical application of bupivacainegauze soaked in 5 ml of 0.5% bupivacaine solution for five minutes in both tonsillar fossae while patients ingroup 2, received nothing. The post operative pain score was assessed on Visual Analogue Scale (VAS) and comparedbetween the groups at 1, 3 and 8 hours.

Results: Out of 96 subjects (48 in each group), 56 (58.3%) were male and 40 (41.7%) female. Mean Pain Score was5.27±2.811 in group 1 & 6.02±2.914 group 2 at 1 hour (p=0.203); 4.81±2.750 in group 1 & 5.60±2.944 group 2 at 3hour (p=0.177) and 4.35±2.605 in group 1 & 5.08±2.901 group 2 at 8 hour (p=0.198).

Conclusion: Topical application of 0.5% bupivacaine provides no significant pain relief in post-tonsillectomy patientsin first 8 hours.

Key Words: Bupivacaine topical, Post-tonsillectomy pain, Visual Analogue Scale.


This article may be cited as:

Khan MI, Shah SF, Muhammad, Iqbal K. Relief of post-tonsillectomy pain by topicalapplication of bupivacaine. Khyber Med Univ J 2012; 4(4): 183-186.

Article Details

How to Cite
Original Articles
Author Biography

syed fahim shah, KIMS

Medicine Assistent Professor


Wornock FF, Lander L. Pain progression, intensity and

outcomes following tonsillectomy. Pain 1998; 75(1):


Kerekhanjanarong V, Tang-On N, Supiyaphun P, Sastarasadhit V. Tonsillar fossa steroids injection for reduction

of the post-tonsillectomy pain. J Med Assoc Thai

; 84:391-5.

Kadar AA, Obaid MA. Effect on postoperative pain after

local application of Bupivacaine in the tonsillar fossa:

A prospective single blind controlled trial. J Pak Med

Assoc 2003; 53:422-6.

James D, Justins D. Acute post-operative pain. A practice

of anaesthesia 7th ed. London: Wylie and Churchill-Davidson

; 1225-9.

Caterall W, Mackie K. Local anaesthetics. In: Hardman

JG, Limbird LE, Molinoff PP, Ruddon RW editors. Goodman

Gillman Pharmacological basis of therapeutics, 9th

Ed. McGraw Hill, New York 1996; 331-47.

Sun J, Wu X, Meng Y, Jin L. Bupivacaine versus normal

saline for relief of post-adenotonsillectomy pain in children:

a meta-analysis. Int J Pediatr Otorhinolaryngol

; 74(4):369-73.

Bean-Lijewski JD. Glossopharyngeal nerve block for

pain relief after pediatric tonsillectomy: Retrospective

analysis and two cases of life threatening upper air way

obstruction from an interrupted trial. Anesth Anal 1997;


Colclasure J, Graham S. Complications of tonsillectomy

and adenoidectomy. In: Eisele D, ed. Complications in

Otolaryngology–Head and Neck Surgery. St Louis, Mo:

Mosby; 1993.

Sharifian HA, Fathololoomi MR, Bafghi AF, Naini SAS.

Effect of local bupivacaine infilteration on post-tonsillectomy

pain. Tanaffos 2006; 5(1):45-9.

Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, et al. Effect of pre versus postoperative tonsillar

infiltration with local anesthetics on postoperative pain

after tonsillectomy. Acta Anaesthesiol Scand 1996;


Singh GB, Yadav SPS, Singh J. Comparative study of

infiltration and surface application of bupivacaine in

post-tonsillectomy pain. Ind J Otolaryngol Head Neck

Surg 2006; 58(2):147-51.

Muhammad SK, Ibraheem AS, Abdelraheem MG. Preoperative intravenous dexamethasone combined with

glossopharyngeal nerve bock: role in pediatric postoperative

analgesia following tonsillectomy. Eur Arch Otolaryngol 2009: 266(11):1815-19.

Ehsan-ul-Haq, Udaipurwala IH, Farrukh MS. Post-tonsillectomy pain reduced by application of bupivacaine

pack in the tonsillar fossa. Pak J Surg 2009; 25(2):76-9.

Hydri AS, Nawaid MA, Afridi JA, Shabbir G. Comparison

of local application versus infiltration of bupivacaine for

post-tonsillectomy pain in adults. Ann Pak Inst Med Sci

; 8(1):3-5.

Hydri AS, Malik SM. Post-tonsillectomy pain and bupivacaine: An intra-individual design study. J Coll Physicians

Surg Pak 2010; 20(8):538-41.

Khan SA, Zaman J. Effect of topical bupivacaine on

post-operative pain after tonsillectomy. Med Channel

; 11(2):30-33.

Hung T, Moore-Gillon V, Hern J, Hinton A, Patel N. Topical

bupivacaine in paediatric day-case tonsillectomy: a

prospective randomized controlled trial. J Laryngol Otol

; 116(1):33-36.

Cyna AM, Bell KR, Flood LM. Cervical osteomylitis after

tonsillectomy. Anesthesia 1997; 52:1084-7.

Weksler N, Nash M, Rozentsveig V. Vocal cord paralysis

as a consequence of peritonsillar infiltration with

bupivacaine: A case report. Acta Anaesthesiol Scand

; 45:1042-44.

Shlizerman L, Ashkenazi D. Peripheral facial nerve paralysis after peritonsillar infiltration of bupivacaine: A case

report. Am J Otolaryng 2005; 56(6):406-7.

Hobson JC, Malla JV. Horner’s syndrome following tonsillectomy. J Laryngol Otol 2006; 120(9): 800-1.

Mazoit JX, Dalens BJ. Pharmacokinetics of local anesthetics

in infants and children. Clin Pharmacokinet 2004; 43:17-32.

Nunez DA, Proven J, Crawford M. Postoperative tonsillectomy pain in paediatric patients: Electrocautery

(hot) vs cold dissection and snare tonsillectomy-a randomized

trial. Arch Otolaryngol Head Neck Surg 2000;126:837-41.

Ataullah N, Kumar M, Hilali A, Hickey S. Postoperative

pain in tonsillectomy: bipolar electrodissection technique

vs dissection ligature technique- a double-blind

randomized postoperative trial. J Laryngol Otol 2000;


Giannoni C, White S, Enneking FK, Morey T. Ropivacaine

with or without clonidine improves pediatric tonsillectomy

pain. Arch Otolaryngol Head Neck Surg 2001;127(10):1265-70.