Vasoconstrictive and analgesic efficacy of locally infiltrated levobupivacaine in tonsillectomy patients Julide Ergil a, *, Taylan Akkaya a , Orhan Gozaydin a , Behcet Gunsoy b , Sibel Alicura b , Ebru Aladag a , Haluk Gumus a ,I ˙ stemihan Akin b a Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Anesthesiology Departement, Turkey b Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ear Nose and Throat Surgery Departement, Turkey 1. Introduction Levobupivacaine is a new long acting amide type local anesthetic that is claimed to have vasoconstrictive activity in 0.25% or less concentrations [1,2]. Although the efficacy of levobupivacaine has been tested in a wide spectrum of operations, there are few clinical studies showing vasoconstrictive activity of levobupivacaine [1]. Tonsillectomy with or without adenoidectomy is one of the most frequent performed procedures in ENT departments. Frequently tonsillectomies are associated with significant periop- erative bleeding and postoperative pain [3]. Peritonsillar injection of various local anesthetics with addition of adrenaline in order to reduce posttonsillectomy pain and perioperative bleeding is one of the strategies that have been developed [4]. Lidocaine–adrenaline combination is commonly used for infiltrative anesthesia because of its rapid action and providing some degree of hemostasis [5]. However, there is also concern of complications due to systemic absorption of adrenaline in patients with arteriosclerosis, hypertension, ischemic heart diseases, anemia and preexisting liver or renal damage and endocrinologic dysfunc- tion [6]. In pediatric tonsillectomies, peritonsillar injection of plain levobupivacaine might be advantageous due to vasoconstrictive activity as well as postoperative analgesic properties. The aim of this study was to compare the effect of preinsicional infiltration of levobupivacaine with lidocaine–adrenaline and saline on perioperative blood loss. We also investigated postoperative analgesic efficacy of both groups in children undergoing tonsillec- tomies. International Journal of Pediatric Otorhinolaryngology 76 (2012) 1429–1433 ARTICLE INFO Article history: Received 25 April 2012 Received in revised form 11 June 2012 Accepted 15 June 2012 Available online 7 July 2012 Keywords: Levobupivacaine Vasoconstrictive effect Blood loss Peritonsillar infiltration Postoperative analgesia ABSTRACT Objectives: The use of preincisional plain levobupivacaine, lidocaine adrenaline and saline for perioperative blood loss and postoperative analgesia in pediatric tonsillectomy patients are compared. Methods: Ninety patients were randomly assigned into one of the 3 groups to receive preincisional peritonsillar infiltration of levobupivacaine 0.25% (group LB), lidocaine–adrenaline 1% with 1:200,000 (group LA) and saline (group S) under general anesthesia. Intraoperative blood loss, pre- and postoperative hemoglobin (hb) and haematocrit (htc) values, hemostasis time, operation duration, number of cautery used (20 W, 1 s) and heart rates were recorded. Pain scores in PACU, at 6th, 12th and 24th hours postoperatively and the number of the patients requiring analgesic treatment for first 24 h was also recorded. Results: There was a 30% reduction in perioperative blood loss in group LB and 63% reduction in group LA compared to group S (39  6, 21  4 and 55  7 ml respectively) (p < 0.001). Eventhough all three groups have significantly lower postoperative hb and htc values with respect to preoperative levels both local anesthetic groups had significantly higher postoperative hb and htc values than saline (p < 0.001). Time required for hemostasis, the number of cautery used for haemostasis and operation duration were lower in groups LB and LA with respect to group S. Pain scores of the group LB revealed a significantly lower score throughout 24 h. Only 14 patients in group LB demanded additional analgesic where as all patients in the other groups had. Adding adrenaline to the local anesthetic solution showed no side effects. Also we did not happened to see any complications related to local anesthetic injections. There was no postoperative major bleeding in groups. Conclusion: Levobupivacaine has a vasoconstrictive effect in 0.25% concentrations that may be beneficial in tonsillectomy patients and has a consistent analgesic effect. ß 2012 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Koza S 114/15, 06670 Gaziosmanpas ¸ a, Ankara, Turkey. Tel.: +90 3125962553. E-mail address: julideergil@hotmail.com (J. Ergil). Contents lists available at SciVerse ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijporl.2012.06.016