الفهرس 
Subject
AnatomyOnly 14 pages are availabe for public view
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Abstract
Purpose : The objective of this study is to assess the analgesic efficacy and safety of preemptive peritonsillar levobupivacaine infiltration alone in comparison with levobupivacaine mixed with DEX infiltration in children undergoing tonsillectomy. Materials and Methods : After the approval of ethical committee (IRB) of Mansoura University, Faculty of medicine, this study was performed at ENT anesthesia unit in Mansoura University Hospital, on 60 patients of American society of anesthesiologist (ASA) physical status grade I or II, aged 6 to 12 years of either sex and scheduled for elective tonsillectomy, an informed written consent was taken from the parents.All patients who were enrolled in this study were randomized Patients were randomly allocated into one of the three study groups with 20 patients in each group, allocation was done by the closed envelop method : group S (control group) receive peritonsillar infiltration saline with total volume of 4ml. group L (receive peritonsillar infiltration of 0.4mg/ kg of 0.5% levobupivacaine) with total volume of 4ml. group LD (receive peritonsillar infiltration of 0.4mg/ kg of 0.5% levobupivacaine plus DEX 1µg/kg) Results : In terms of hemodynamic parameters there was significant difference as regard HR, it was significantly decreased in group LD when compared to group L and group S in the following intervals ; 10, 20, 30, 40, 50; 60 minutes after induction of anesthesia, immediate and 1h postoperative. In addition, MBP showed significant decrease in group LD when compared to group L and group S in the following intervals; 10, 20, 30, 40, 50; 60 minutes after induction of anesthesia, immediate and 1h postoperative. Postoperative sedation was assessed using Ramsey sedation scale and it was significantly high in group LD when compared to group L and group S in the following intervals; on arrival to PACU, 15, 30 min, 1h postoperative. Postoperative pain during rest was assessed using VAS score, it was significantly decreased in group LD when compared to group L&S (P 0.001 for all comparisons) in the following intervals; 30 min ,1h,2h ,4h,6 h ,12h ,24 h postoperatively. Postoperative VAS at swallowing was also significantly decreased in group LD when compared to group L&S (P 0.001 for all comparisons) in the following intervals; 2h, 4h, 6h, 12h, 24 h postoperative periods. They reported less pain in the 2nd and 3rd postoperative days using VRS, in group LD compared to group L&S (P 0.001 for both comparisons).VRS also significant in 4th day postoperatively but less than 2nd and 3rd day. Postoperative time to first request of supplemental analgesics was highly significant in group LD (11.10 ± 1.02) when compared to group L (8.55 ± 0.60) hours and group S (4.50 ± 1.00) hours. Conclusion : In the present study we concluded that addition of dexmedetomidine to levobupivacaine for peritonsillar infiltration in patients undergoing tonsillectomy surgery provided better decrease of post tonsillectomy pain, decrease 1st analgesic request and decreased total analgesic consumption without causing any adverse effects. Recommendation : Further clinical studies are required for the most suitable regimen for levpbuopivacainne.