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Research Article Volume 3 Issue 1
Infiltration with Lidocaine 2%, Dexmedetomidine + Levobupivacaine 5% for Post Tonsillectomy Analgesia
Sabina ER Ferrer,
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Campillo M, García N
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President of Regional Anesthesia and Pain Venezola Ultrasound Society of Anesthesiology, Venezuela
Correspondence: Sabina Elisa Romero Ferrer, President of Regional Anesthesia and Pain Venezola Ultrasound Society of Anesthesiology, Venezuela, Tel 584142910791
Received: June 30, 2014 | Published: September 7, 2015
Citation: Ferrer SER, Campillo M, Garcia N (2015) Infiltration with Lidocaine 2%, Dexmedetomidine + Levobupivacaine 5% for Post Tonsillectomy Analgesia. J Anesth Crit Care Open Access 3(1): 00081. DOI: 10.15406/jaccoa.2015.03.00081
Keywords
dexmedetomidine, levobupivacaine; lidocaine
Introduction
The swelling of the Pharynx and tonsils is one of the most frequent reasons of consulting in the ORL sphere. They can be acute or chronic, defining the latter as the precense of 5 infectious episodes in a year. The diagnosis is clinical, the most frequent etiology is viral (adenovitis and rinovitis),1 only a 10-30% is bacterial, specifically Type A Beta Hemolytic streptococci Beta (EBHGA).2
Generally it can be said that the indications to explain tonsil extirpation3 and adenoids include the obstruction degree and interference that these structures produce in the normal physiological functions of the faringue, Eustachian Tube or Posterior Nasal Apertures. The infiltration of pre-surgical local anesthetics has come to be a highly popular coadjutant in General Anesthesia, in the ambulatory environment. The use of local anesthetics facilitates recovery giving intra and post-operatory analgesia. It contributes to a reduction of the consumptions of analgesics and an earlier return to the functional state. The alpha adregenics produce analgesia due to their effect in the receivers of the dorsal horn in the spinal cord. The main objective of this study is to prove the analgesic efficacy of the infiltration of local anesthetics joined to the alpha agonists 2 adregenics in patients undergoing tonsillectomy.
Material and methods
It’s a clinical study, prospective and controlled, where I include a total of 50 patients of both sexes, ASA I, ages between 2 and 8years, with indications of tonsillectomy surgical intervention, between March 2006 and March 2007. Under standard ASA Monitoring, a Premeditation with Midazolam, Metroclopramide and Ranitide was carried out, the anesthetic induction was carried out with Propofol, (2-3mg/kg), and Esmeron (0,3mg/kg) the maintenance anesthetics was carried out with Isoflurane (1,5%), Oxygen (3lts/min). We proceeded to the realization of the surgical procedure of Tonsillectomy, and after concluding it and before to the reversal of the anesthesia, an infiltration of the analgesic mixture with Lidocaine at 2% (1mg/kg), Levobupivacaine (5mg) and Dexmedetomidine (0.3mg/kg) was carried out at approximately 2cm above the upper pole where the tonsil was at, previous aspiration with a 23x1 1/2 inches needle, said infiltration was done bilaterally. Evaluation in the Post-Anesthesic Care Unit during the first 2hours, the EVA, sedation scale using the RAMSAY scale, consumption of analgesics, Hemodynamical variables. The evaluation was continued during the first 24 hours. Likewise the satisfaction scale of the patient was evaluated when discharged (Figure 1).
Figure 1 The satisfaction scale of the patient was evaluated when discharged.
Results
Regarding the hemodynamical variables of the cardiac frequency, respiratory frequency, arterial tension, there was no significant statistical difference. The sedation level according to the RAMSAY scale, there was no statistical difference, neither where complications presented or adverse effects. Regarding the request of post-operatory analgesic, the reduction was statistically significant. The EVA was always lower than 2 points, at the first 6 hours cold fluid intake began, there was no complaints of pain. The satisfaction scale that was measured since the first 6 hours reported that there was high acceptance from both patients and mothers (Figure 2).
Figure 2 The satisfaction scale that was measured since the first 6 hours reported that there was high acceptance from both patients and mothers.
Discussion
The reduction of pain is justified since there are works in existence that proof the analgesic efficacy of local anesthetics,4 however here we propose the use of local anesthetics+adregenics 2 alphagonists,.5 and their post-surgical placement, infiltrating the zone close to the one submitted to surgery. Generally the post-operatory anesthesia in patients submitted to tonsillectomies is carried out under intravenous or suppository according to the case, giving good results. The infiltration of local anesthetics blocks the transmission of the painful impulse.6-8 The surgical procedure of tonsillectomy is very cruel in most cases and its post- operative pain especially in the first 24 hours is of great intensity. The use of post-operatory analgesics is the routine technique carried out for post-operatory analgesia (Figure 3).
Figure 3 The use of post-operatory analgesics is the routine technique carried out for post-operatory analgesia.
Conclusion
The results obtained in this study prove the analgesic efficacy of the infiltration of Lidocaine at 2%, Levobupivacaine at 5% and Dexmedetomidine, after the realization of the tonsillectomy. We recommend the use of a mixture of local analgesics mixed with alphagonists 2 adrenergic. In patients that will be submitted to surgical procedure in ORL. We suggest the realization of future research and therapeutic works to be used in this type of surgery.
Acknowledgments
None.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Funding
None.
References
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- Barash, Paul, Cullen y Stoeling. Manua de anestesia general, Tercera edición. Mexico: Mc Graw hill Interamericana; 1999.
- Nebreda, Carlos, Urban Bruno. Manual de fármacos utilizados en el tratamiento del dolor crónico. 1st edn. IASP Press; 2001. pp. 178.
- Michael J, Briden B. Bloqueos nerviosos en anestesia clínica y tratamiento del dolor. Spain: Doyma, Barcelona España; 1991.
- Douglas RM, Miles H. Acute Tonsilletis in children: Microbial pathogens in relation to age. Pathology. 1984;16(1):79–82.
- Ritter FN .Tonsillectomy and Adenoidectomy. Indication and complications. Postgrad Med. 1967;41(4):342–347.
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