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Comparative Study Between Bupivacaine Infiltration, Topical Lidocaine and Intravenous Paracetamol in Management of Post-Tonsillectomy Pain in Children

Background: Tonsillectomy operation is a one of the most commonly performed procedures in pediatric population. Post-operative pain control in those children is very important. 
Objective: To compare the efficacy of bupivacaine infiltration in gloss-tonsillar sulcus, applying a gauze soaked in lidocaine (10%) in tonsillar bed and intravenous injection of paracetamol in management of post-tonsillectomy pain in children. 
Patients and Methods: Sixty kids of both sexes were included in this clinical randomized study, aged from 5to 12 years undergoing tonsillectomy at Al-Azhar university hospitals between January 2019 and December 2019. They were randomly allocated into three equal groups: Group (A) underwent pre-operative single-point superficial infiltration of a dose of 1 mg/kg bupivacaine (0.5%) in glosso-tonsillar sulcus, Group (B) underwent post-operative application of a soaked piece of gauze in lidocaine (10%) in the tonsillar bed, and Group (C) underwent preoperative intravenous infusion of 10mg/ml paracetamol solution. They were followed up to assess the effectiveness and safety of which medication in pain management post tonsillectomy. 
Results: There was no statistically significant difference between pain scores in the three groups after 30 minutes, 2 and 6 hours. There was a statistically significant difference between pain scores in the three groups after 12, 18 and 24 hours respectively. Pair-wise comparisons between the groups revealed that Group B showed the statistically significantly highest mean pain score. There was no statistically significant difference between Group A and Group C; both showed the statistically significantly lowest mean pain scores. 
Conclusion: The glossopharyngeal nerve block with plain bupivacaine (0.5%) in glooso-tonsillar sulcus is a safe, effective &easily applicable method for post-tonsillectomy pain management and has a significant prolonged duration of analgesia in comparison to topical lidocaine and Intravenous paracetamol. However, paracetamol injection was more effective than lidocaine infiltration.