Comparison of intravenous fentanyl and infiltration of bupivacaine and clonidine in decreasing post tonsillectomy pain and complications in children

Abstract

Objectives: Tonsillectomy is one of the most common surgeries in the world which is accompanied by severe postoperative pain. Recently local drug infiltration is being used for pain control, but the results are controversial. Thus we planned a study to evaluate the effect of infiltration of bupivacaine and clonidine on decreasing post-tonsillectomy pain and complications in children. Methods: In a double-blind randomized clinical trial, 140 children (3-12 y) scheduled to undergo tonsillectomy in Tabriz Children Hospital were studied. The patients were randomized into two 70-patient groups and received intravenous fentanyl (1?g/kg) (group F) or intravenous fentanyl (1?g/kg) plus infiltration of bupivacaine 0.25% (0.1ml/kg) and clonidine (1?g/kg) (group BC). Post-operative pain was evaluated using Wong-Baker Face Pain Scale (FPS). Results: The pain score was significantly lower in the BC patients in comparison with group F (p<0.001). The need for postoperative analgesics was also lower in BC group (p<0.001). Frequency of subjects with intraoperative bleeding was significantly lower in the BC group compared with F group (1.4% vs. 10%; p=0.031). However, frequency of subjects with intraoperative pain was not significantly different between the two groups (8.5% vs. 11.4%; p=0.573). Conclusion: Based on our results, infiltration of bupivacaine and clonidine in children undergoing tonsillectomy is more efficacious than single IV fentanyl in decreasing post-operative pain. This approach is also safer regarding the intraoperative complications.