Ropivacaine with or without clonidine improves pediatric tonsillectomy pain.

OBJECTIVE

To determine if preemptive analgesia with ropivacaine hydrochloride with or without clonidine hydrochloride decreases pain and hastens recovery after tonsillectomy.

DESIGN

Prospective, randomized, triple-blinded trial.

SETTING

University referral center; pediatric ambulatory practice.

PARTICIPANTS

Sixty-four children, aged 3 to 15 years, undergoing tonsillectomy.

INTERVENTIONS: Patients received injections in the tonsillar fossae of isotonic sodium chloride, ropivacaine, or ropivacaine plus clonidine prior to tonsil excision.

MAIN OUTCOME MEASURES: Visual analogue (pain) scale scores at rest and when drinking, opioid use, recovery time to normal activity, and incidence of symptoms such as otalgia.

RESULTS

Pain was reduced on postoperative day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups as compared with the isotonic sodium chloride-treated group (P<.05). Pain was also decreased in the ropivacaine plus clonidine-treated group on postoperative days 3 and 5 (P<.05). Intravenous narcotic use was decreased on day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups (P<.05). Cumulative codeine use was similar at day 3 for all patients, but was decreased at day 5 in the ropivacaine plus clonidine-treated group (P<.05). The incidence of otalgia decreased from 89% (16/18) in the isotonic sodium chloride-treated group to 63% (12/19) in the ropivacaine-treated and 61%(11/18) in the ropivacaine plus clonidine-treated groups (P<.01). Recovery to normal activity was shortened from 8.1 +/- 1.6 days to 5.8 +/- 2.9 days (mean +/- SD) in the isotonic sodium chloride-treated and ropivacaine plus clonidine-treated groups, respectively (P =.03).

CONCLUSION

Preincisional injection of ropivacaine with clonidine prior to tonsillectomy has a preemptive analgesic effect that outlasts the local anesthetic and decreases pain, opioid use, and the time to return to normal activity.