Levobupivacaine and Levobupivacaine+Adrenalin in Pediatric Tonsillectomy Operations.

A total of 90 American Society of Anaesthesiologists class 1 or 2 (ASA I-II) patients between the ages of five and twelve participated in the study. After anaesthetic induction and before the operation, the patients were divided into groups. Levobupivacaine only (0.5%) 0.4 mg.kg-1 for group L (n=45), levobupivacaine (0.5%) 0.4 mg.kg-1+adrenaline (1:200.000) for group LA (n=45) were prepared for each tonsillar fossae. For each tonsillar fossae, 2.5 ml of the solution was injected as a withering and swollening submucosal infiltration in sterile conditions to the inferior and superior poles and to all areas surrounding the plicae of both tonsillar fossae by the otolaryngologist, who did not know which group was receiving which treatment. Anaesthesia was maintained by using 50% O2+ 50% N2O and 2% sevoflurane. The period between the placement of the mouth retractor for the operation and the removal of the mouth retractor after bleeding was controlled was recorded as the duration of the surgery. The perioperative amount of bleeding was deduced by measuring the aspirator apparatus and the swabs used and calculating the weight of the physiological saline solution before and after the operation. Cautery and suture use for the patients also were recorded. The patients were monitored in the postanesthesia care unit (PACU) postoperatively. The parents were taken into the PACU to decrease postoperative anxieties that the children might feel because they were in an unfamiliar environment. If present, diplopia, hallucination, cough, facial paralysis, vocal cord paralysis, bronchospasm, and postoperative bleeding were recorded as postoperative complications. At the end of the operation, the follow-up was taken over by an anaesthesiologist who did not know the study groups. In this way, the double-blind study protocol was maintained. Postoperatively, at the 10th, 30th, and 60th minutes and the 6th, 12th, and 24th hours, the pain scores of the patients were assessed by using the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS), and nausea and vomiting were assessed by measuring postoperative nausea and vomiting (PONV:0 = no nausea or vomiting; 1= nausea but no vomiting; 2 = vomited once in 30 minutes; 3 = two or more episodes in 30 minutes). The modified Aldrete score (MAS) was used as a recovery criterion, and a MAS greater than 8 was considered to indicate recovery. For patients with a CHEOPS score greater than 6, pain treatment was conducted with intravenous asetaminofen within the first 6 hours and oral asetaminofen after the first 6 hours at a dose of 10 mg.kg.h-1. The time to the first analgesic request and the total amount of analgesic administered were recorded. If the PONV score was higher than 3, patients were treated with 150 µg.kg-1 of metoclopramide intravenously.