A clinical study of effect of peri-tonsillar infiltration of ropivacaine on tonsillectomy haemorrhage
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20220041Keywords:
Tonsillectomy, Peri tonsillar infiltration, Ropivacaine, HaemorrhageAbstract
Background: The aim of this study to determine the relationship between the peritonsillar infiltration of ropivacaine hydrochloride and haemorrhage in patients undergoing tonsillectomy.
Methods This prospective study was conducted in the department of otorhinolaryngology and head and neck surgery, Adichunchanagiri institute of medical sciences, B. G. Nagara, Mandya district. A sample size of 30 patients which satisfied the inclusion criteria were included in the study.
Ropivacaine (0.75%) was locally infiltrated on the right side (R-side) in the peri-tonsillar region before the surgery. The left side was considered as the control side. Intra-operative blood loss was estimated separately for both the sides. The data from the study will be analysed using chi square test and Student t test technique.
Results: The 17 (56.7%) females and 13 (43.3%) males participated in the study. Majority of the cases belonged to <10 years of age group. By analysing the data, blood loss was found to be higher on the left side (control side) compared to the right side on which peri-tonsillar infiltration of ropivacaine was given. The association between the blood loss on the right side and the left side (control side) was found to be significant (p<0.0001).
Conclusions: Based on the result of our study it can be derived that the peri-tonsillar infiltration of Ropivacaine (0.75%) is very effective in reducing intra-operative bleeding and at the same time providing a better bloodless field during surgery. Hence, we recommend the use of peri-tonsillar infiltration of Ropivacaine (0.75%) in view of better management of intra-operative blood lossissn.2454-5929.ijohns20220041
References
Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, et al. Effect of pre- vs. postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand. 1996;40(10):1210-5.
Windfuhr J, Chen Y, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head and Neck Surg. 2005;132(2):281-6.
Rashiq S, Finucane BT. Nerve conduction and local anesthetic action. In: Healy TEJ, Knight PR. A Practice of Anesthesia. 7th ed. London: Wylie and Churchill Davidson. 2003;267-76.
Lee A, Fagan D, Lamont M, Tucker GT, Halldin M, Scott DB. Disposition kinetics of ropivacaine in humans. Anesth Analg. 1989;69:736-8.
Arthur G, Feldman H, Covino B. Comparative pharmacokinetics of bupivacaine and ropivacaine, a new amide local anesthetic. Anesth Analg. 1988;67:1053-8.
Stichartz GR, Berde CB. Local Anesthetics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 6th ed. New York: Churchill Livingstone. 2004;73-99.
Bangera A. Anaesthesia for adenotonsillectomy: An update. Indian J Anaesth. 2017;61:103-9.
Apostolopoulos K, Labropoulou E, Samaan R, Bogris K. Ropivacaine compared to Lidocaine for Tonsillectomy under localanaesthesia. Eur Arch Otorhinolaryngol. 2003;260:355-7.
Bameshki AR, Razban M, Khadivi E, Razavi M, Bakhshaee M. The effect of local injection of Epinephrine and Bupivacaine on post-tonsillectomy pain and bleeding. Iran J Otorhinolaryngol. 2013;25(73):209-14.
Cassuto J, Sinclair R. Anti-inflammatory properties of local anaesthetics and their present and potential clinical implications. Acta Anaesthesiologica Scandinavica A pril. 2006;50(3):265-82.
Metaxotos NG, Asplund O, Hayes M. The efficacy of bupivacaine with adrenaline in reducing pain and bleeding associated with breast reduction: A prospective trial. Br J Plast Surg. 1999;52:290-3.
Knudsen K, Beckman SM, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of IV infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-14.
Kuthiala G, Chaudhary G. Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth. 2011;55:104-10.
Leão P, Castro D, Pacheco M, Soares JC, Afonso D. Outcome of combined peribulbar ropivacaine 0.75% block and general anesthesia for retinal detachment surgery: A randomized controlled study. Egypt J Anaesth. 2016;32(4):549-53.
Budharapu A, Sinha R, Uppada UK, Subramanya Kumar AV. Ropivacaine: a new local anesthetic agent in maxillofacial surgery. Br J Oral Maxillofac Surg. 2015;53:451-4.
Mishra A, Lalani Z, Kalakonda B, Krishnan P. Comparative evaluation of hemodynamic, vasoconstrictive, and SpO2 variability during different stages of periodontal surgery performed using 0.5% ropivacaine or 2% lignocaine HCl (1:80,000 adrenaline) local anesthesia: A randomized, double-blind, split-mouth pilot study. J Indian Soc Periodontol. 2018;22(3):243-8.
