1 Department of Surgery/ School of Medicine/ University of Sulaimani

2 Department of 0tolaryngology/ Head and Neck Surgery/ Sulaimani Teaching Hospital


Objective: To reduce early post-tonsillectomy pain by using local anesthetic agents and encouraging early swallowing and decreasing the risk of dehydration, infection and secondary bleeding. Patients and Methods: This study was undertaken on 99 patients (for whom tonsillectomy done under general anesthesia), between ages of 8 - 42 years, to compare the efficacy of topical application of (4%) lignocaine, (0.5%) bupivacaine, and normal saline in reducing postoperative pain after tonsillectomy. Patients were divided into 3 groups, each group composed of 33 patients. Group I, in whom (0.5%) bupivacaine was used, in group II (4%) lignocaine was used, and in group III (control group) normal saline was used. After removal of both tonsils, a gauze measuring 2.4 centimeter square mixed with 2.0 ml of either (0.5%) bupivacaine, (4%) lignocaine, or normal saline according to the group was kept in both tonsillar fossae for a period of 5 minutes. Postoperative pain was assessed using the Wong - Baker Faces pain rating scale up to a period of 24 hours after surgery. Results: There was a significant difference in pain intensity between the control group and the other groups in first, fourth, eighth, and twenty fourth hours postoperatively (p<0.05), but not in second hour (p>0.05). The accumulated scores for pain, dysphagia and difficulty in speaking were significantly lower in groups I (bupivacaine) and II (lidocaine) as compared to group III (normal saline) (p <0.05), while scores of group II were significantly lower than those in group I (p<0.05). Conclusion: Topical application of (4%) lignocaine and (0.5%) bupivacaine in the tonsillar bed is a safe and effective method of reducing postoperative pain following tonsillectomy that if not treated may devoid the patient from swallowing and lead to dehydration, infection and secondary bleeding. Study design: A single blind prospective comparative clinical study.