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International Journal of Pharmacology

Year: 2015 | Volume: 11 | Issue: 5 | Page No.: 490-495
Research Article

Levobupivacaine Alone Versus Levobupivacaine Plus Magnesium Infiltration for Post-Tonsillectomy Analgesia

Mohammad Waheed El-Anwar
Department of Head and Neck Surgery, Faculty of Medicine, Zagazig University, Egypt
Khalid Mostafa
Department of Anesthesia ICU and Otolaryngology,
Akmal Abd- Elsamad
Department of Anesthesia ICU and Otolaryngology,
Tonsillectomy (±adenoidectomy) is performed for recurrent tonsillitis or obstruction of the upper airway. Post tonsillectomy pain cumulates within first postoperative days and decreases gradually following the fourth day in pediatric patients with many adverse effects on the patients with 1% readmission was reported due to dysphagia and dehydration. The present study has been planned to assess the analgesic effect of tonsillar bed infiltration of levobupivacaine compared to levobupivacaine and magnesium after tonsillectomy in pediatric patients. Eighty American Society of Anesthesiologists (ASA) I children aged 7-13 years scheduled for elective tonsillectomy (±adenoidectomy) were included in current study. The patients’ Visual Analogue Scale (VAS) for pain were registered at 15th min after arrival to Postanesthesia Care Unit (PACU) and 1st, 2nd, 3rd, 6th, 12th and 24th h postoperatively. The time at the first analgesia request and additional analgesic requirements were also reported and patients were followed up for one week. Postoperative bleeding, infection, Post-Operative Nausea and Vomiting (PONV), abdominal pain, constipation, arrhythmia and allergic reactions were documented. Levobupivacaine plus magnesium gave significantly less VAS of pain in comparison to levobupivacaine alone at 12 and 24 h postoperatively. While this lower VAS of pain was found statistically non-significant at earlier periods of assessment. In addition, the time to first analgesic request was lengthened and total number of analgesic requests in the first 24 h were decreased in combined group when compared to levobupivacaine alone. In addition, laryngospasm significantly decreased in levobupivacaine plus magnesium group with no reported increase in complications. Adding magnesium to Levobupivacaine local infiltration in tonsillar bed is safe and significantly augments the analgesic effect of levobupivacaine after tonsillectomy in pediatric patients.
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References

  1. Akoglu, E., C.A. Akkurt, K. Inanoglu, S. Okuyucu and S. Dagli, 2006. Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: A randomized controlled study. Int. J. Pediatr. Otorhinolaryngol., 70: 1169-1173.
    CrossRefDirect Link
  2. Amin, S.M., 2014. Evaluation of gabapentin and dexamethasone alone or in combination for pain control after adenotonsillectomy in children. Saudi J. Anaesth., 8: 317-322.
    CrossRefDirect Link
  3. Bameshki, A.R., M. Razban, E. Khadivi, M. Razavi and M. Bakhshaee, 2013. The effect of local injection of epinephrine and bupivacaine on post-tonsillectomy pain and bleeding. Iran. J. Otorhinolaryngol., 25: 209-214.
    Direct Link
  4. Begon, S., G. Pickering, A. Eschalier and C. Dubray, 2002. Magnesium increases morphine analgesic effect in different experimental models of pain. Anesthesiology, 96: 627-632.
    Direct Link
  5. Breschan, C., R. Jost, R. Krumpholz, F. Schaumberger, H. Stettner, P. Marhofer and R. Likar, 2005. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patients undergoing caudal blockade. Pediatr. Anesth., 15: 301-306.
    CrossRefDirect Link
  6. Cho, H.K., K.W. Kim, Y.M. Jeong, H.S. Lee, Y.J. Lee and S.H. Hwang, 2014. Efficacy of ketamine in improving pain after tonsillectomy in children: Meta-analysis. PLoS One, Vol. 9.
    CrossRefDirect Link
  7. Colclasure, J. and S. Graham, 1993. Complications of Tonsillectomy and Adenoidectomy. In: Complications in Otolaryngology-Head and Neck Surgery, Eisele, D. (Ed.). Mosby Co., St. Louis, MO.
  8. Elnashar, I., W.E. El-Anwar, W.M. Basha and M. AlShawadfy, 2014. Objective assessment of endoscopy assisted adenoidectomy. Int. J. Pediat. Otorhinolaryngol., 78: 1239-1242.
    CrossRefDirect Link
  9. Freeman, S.B. and J.K. Markwell, 1992. Sucralfate in alleviating post-tonsillectomy pain. Laryngoscope, 102: 1242-1246.
    CrossRefDirect Link
  10. Grainger, J. and N. Saravanappa, 2008. Local anaesthetic for post-tonsillectomy pain: A systematic review and meta-analysis. Clin. Otolaryngol., 33: 411-419.
    CrossRefDirect Link
  11. Gristwood, R.W., 2002. Cardiac and CNS toxicity of levobupivacaine. Drug Saf., 25: 153-163.
    CrossRefDirect Link
  12. Gulhas, N., M. Durmus, S. Demirbilek, T. Togal, E. Ozturk and M.O. Ersoy, 2003. The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: A preliminary study. Paediatr. Anaesth., 13: 43-47.
    CrossRefDirect Link
  13. Gunduz, A., A. Bilir and S. Gulec, 2006. Magnesium added to prilocaine prolongs the duration of axillary plexus block. Reg. Anesth. Pain Med., 31: 233-236.
    CrossRefPubMedDirect Link
  14. Hartley, M. and R.S. Vaughan, 1993. Problems associated with tracheal extubation. Br. J. Anaesth., 71: 561-568.
    Direct Link
  15. Hashish, M. and A. Diab, 2011. Levobupivacaine plus magnesium used for postoperative analgesia in pediatric tonsillectomy patients compared to levobupivacaine alone. Asian Acad. Manage. J., 9: 261-277.
    Direct Link
  16. Jebeles, J.A., J.S. Reilly, J.F. Gutierrez, E.L. Bradley and I. Kissin, 1991. The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain, 47: 305-308.
    CrossRefDirect Link
  17. Joshi, G.P. and B.O. Ogunnaike, 2005. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol. Clin. North Am., 23: 21-36.
    Direct Link
  18. Karaaslan, K., F. Yilmaz, N. Gulcu, A. Sarpkaya, C. Colak and H. Kocoglu, 2008. The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients. Int. J. Pediatr. Otorhinolaryngol., 72: 675-681.
    CrossRefDirect Link
  19. Kaygusuz, I.I. and N. Susaman, 2003. The effects of dexamethasone, bupivacaine and topical lidocaine spray on pain after tonsillectomy. Int. J. Pediatr. Otorhinolaryngol., 67: 737-742.
    CrossRefDirect Link
  20. McLeod, G.A. and D. Burke, 2001. Levobupivacaine. Anaesthesia, 56: 331-341.
    CrossRefDirect Link
  21. Nikandish, R., B. Maghsoodi, S. Khademi, S. Motazedian and R. Kaboodkhani, 2008. Peritonsillar infiltration with bupivacaine and pethidine for relief of post-tonsillectomy pain: A randomised double-blind study. Anaesthesia, 63: 20-25.
    CrossRefDirect Link
  22. O'Flaherty, J.E. and C.X. Lin, 2003. Does ketamine or magnesium affect posttonsillectomy pain in children. Paediatr. Anaesth., 13: 413-421.
    CrossRef
  23. Orntoft, S., A. Longreen, S. Moiniche and J.B. Dhal, 1994. A comparison of pre- and postoperative tonsillar infiltration with bupivacaine on pain after tonsillectomy A pre-emptive effect? Anaesthesia, 49: 151-154.
    CrossRefDirect Link
  24. Page, G.G., 2003. The immune-suppressive effects of pain. Adv. Exp. Med. Biol., 521: 117-125.
    Direct Link
  25. Park, A.H., A.L. Pappas, E. Fluder, S. Creech, A.R. Lugo and A. Hotaling, 2004. Effect of perioperative administration of ropivacaine with epinephrine on postoperative pediatric adenotonsillectomy recovery. Arch. Otolaryngol. Head Neck Surg, 130: 459-464.
    CrossRefDirect Link
  26. Rowe, B.H., J.A. Bretzlaff, C. Bourdon, G.W. Bota and C.A. Camargo Jr., 2000. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature. Ann. Emerg. Med., 36: 181-190.
    CrossRefDirect Link
  27. Safavi, M., A. Honarmand, M.R. Habibabady, S. Baraty and O. Aghadavoudi, 2012. Assessing intravenous ketamine and intravenous dexamethasone separately and in combination for early oral intake, vomiting and postoperative pain relief in children following tonsillectomy. Med. Arch., 66: 111-115.
    Direct Link
  28. Schoem, S.R., G.L. Watkins, J.J. Kuhn, J.F. Alburger, K.Z. Kim and D.H. Thompson, 1993. Control of early postoperative pain with bupivacaine in adult local tonsillectomy. Arch. Otolaryngol. Head Neck Surg, 119: 292-293.
    CrossRefDirect Link
  29. Sirvinskas, E. and R. Laurinaitis, 2002. Use of magnesium sulfate in anesthesiology. Medicina, 38: 695-698.
    Direct Link
  30. Somdas, M.A., M. Senturk, I. Ketenci, U. Erkorkmaz and Y. Unlu, 2004. Efficacy of bupivacaine for post-tonsillectomy pain: A study with the intra-individual design. Int. J. Pediatr. Otorhinolaryngol., 68: 1391-1395.
    CrossRefDirect Link
  31. Tas, E., V. Hanci, M.B. Ugur, I.O. Turan, V.B. Yigit and F. Cinar, 2010. Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation. Int. J. Pediatr. Otorhinolaryngol., 74: 1171-1175.
    CrossRefDirect Link
  32. Vahabi, S., T. Shoja, S. Chaibakhsh, M. Khak and N. Saljoughi, 2012. Effect of postoperative topical administration of magnesium sulfate on pain relief in paediatric adenotonsillectomy: A randomised controlled study. HK J. Paediatr., 17: 109-114.
    Direct Link
  33. Warnock, F.F. and J. Lander, 1998. Pain progression, intensity and outcomes following tonsillectomy. Pain, 75: 37-45.
    CrossRefDirect Link
  34. Yilmaz, S., Y. Demiraran, N. Akkan, H. Yaman, A. Iskender, E. Guclu and O. Ozturk, 2009. The effects of topical levobupivacaine on morbidity in pediatric tonsillectomy patients. Int. J. Pediatr. Otorhinolaryngol., 73: 1208-1210A.
    CrossRefDirect Link
  35. Zainon, I.H., R. Salim and M.K.M. Daud, 2014. Coblation tonsillectomy versus dissection tonsillectomy: A comparison of intraoperative time, intraoperative blood loss and post-operative pain. Med. J. Malaysia, 69: 74-78.
    Direct Link

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