Peritonsillar bupivacaine infiltration reduces emergence delirium after tonsillectomy in children: a randomized, double-blind, controlled study
Signa Vitae, cilt.21, sa.10, ss.61-71, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 21 Sayı: 10
- Basım Tarihi: 2025
- Doi Numarası: 10.22514/sv.2025.144
- Dergi Adı: Signa Vitae
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Central & Eastern European Academic Source (CEEAS), EMBASE
- Sayfa Sayıları: ss.61-71
- Anahtar Kelimeler: Emergence delirium, Tonsillectomy, Bupivacaine, Infiltration analgesia, Postoperative pain
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: The study aimed to evaluate the effect of peritonsillar bupivacaine infiltration on the development of postoperative emergence delirium (ED) in pediatric patients undergoing tonsillectomy or adenotonsillectomy. Methods: This prospective, randomized, controlled clinical trial included 80 pediatric patients aged 3 to 7 years, classified as American Society of Anesthesiologists (ASA) Physical Status I. Patients were randomly divided into 2 groups of 40 patients each: Group A (peritonsillar bupivacaine injection) and Group B (control). In the recovery unit, delirium was assessed with the Pediatric Emergence Delirium Scale (PAEDS) and pain was assessed with the Face, Legs, Activity, Cry and Consolability (FLACC) scale at baseline and at 5, 10, 20, 30 and 60 minutes after surgery. A PAEDS score of ≥10 was considered indicative of postoperative delirium, and 0.5 µg/kg fentanyl was administered intravenously (IV). The FLACC scores ≥4 were considered indicative of pain, and 10 mg/kg paracetamol IV was administered as rescue analgesic. Results: The rate of rescue analgesic use, rescue fentanyl, and the incidence of delirium were significantly lower in group A compared to group B (p = 0.001, p = 0.001 and p = 0.001, respectively). The 20th, 30th and 60th minute FLACC measurements of group A were found to be significantly lower than those in group B (p = 0.002, p = 0.001 and p = 0.001). No significant differences were observed in PAEDS scores between the groups. The group assignment and PAEDS scores at the 5th minute were found as independent risk factors for the development of ED. In comparison to Group A (infiltration), the risk of delirium was higher in Group B (adjusted Odd Ratio (aOR): 14.533, 95% Confidence Interval (CI): 1.766–119.620). Additionally, a one-unit increase in PAEDS score at the 5th minute was associated with a 2.362-fold increased risk of delirium (95% CI: 1.44–3.87). Conclusions: Peritonsillar bupivacaine infiltration significantly reduces the risk of postoperative ED in pediatric patients undergoing tonsillectomy or adenotonsillectomy. Clinical Trial Registration: The study was registered with ClinicalTrials.gov as NCT06863714.