Glossopharyngeal nerve block versus tonsillar fossa ropivacaine infiltration within multimodal analgesia for pediatric post-tonsillectomy pain: a randomized controlled clinical trial.

PURPOSE: Pediatric tonsillectomy is associated with substantial postoperative pain. We compared glossopharyngeal nerve block (GNB) with peritonsillar ropivacaine infiltration (RI) within multimodal analgesia.

METHODS

In this double-blind randomized trial, 90 children (4-10 years) undergoing day-case tonsillectomy were randomly allocated in a 1:1:1 ratio (30 per group) to receive bilateral GNB with 0.2% ropivacaine, RI with 0.2% ropivacaine, or sham control. The primary outcome was post-anesthesia care unit (PACU) pain measured by the Face, Legs, Activity, Cry, Consolability (FLACC) scale; secondary outcomes included pain at rest and during swallowing measured by the Wong-Baker FACES Pain Rating Scale (FACES) at rest and during swallowing (2-24 h), time to first analgesic request, nausea, sleep quality, parental satisfaction, and adverse events.

RESULTS

Time to first analgesic request was significantly longer in the GNB group than in the control group (median 240 vs. 120 min; P < 0.001). Pain at rest was lower with GNB than control from 2 to 12 h and lower than RI at 6 h, and swallowing pain was lower with GNB than both comparators from 2 to 24 h (all P ≤ 0.008) . Nausea was less frequent with GNB (6.7%) than RI (20%) or control (33.3%) (P = 0.036), and sleep quality and parental satisfaction were higher with GNB (P = 0.010 and P < 0.001). PACU FLACC and sedation scores were similar, and no serious anesthetic-related arrhythmias or bronchospasm were observed.

CONCLUSIONS

Within the studied multimodal analgesic regimen, bilateral GNB with 0.2% ropivacaine was associated with lower postoperative pain scores, improved swallowing comfort, longer time to first rescue analgesia, and better caregiver-reported outcomes in this randomized cohort, without increased sedation or observed major anesthetic-related complications.