Skip to main content

Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy



Tonsillectomy is one of the most commonly performed surgeries in ENT practice. Despite improvements in anesthetic and surgical techniques, post-tonsillectomy morbidities continue to be a significant clinical concern. Pain is the cause of most of the postoperative morbidity after tonsillectomy. An effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice.


The present study compares the results between the effect of lidocaine 2% infiltration, lidocaine 10 % spray, and bupivacaine 0.5% spray in the tonsillar bed after tonsillectomy on postoperative pain.

Materials and methods

The study included a total of 120 patients aged 5–18 years who were candidates for tonsillectomy at the Otorhinolaryngology Department of Alexandria Main University Hospital. The patients were randomly divided into three groups of 40 patients each. Group A received lidocaine 2% (Xylocaine) peritonsillar infiltration 2ml in one tonsillar bed and posterior pillar; group B received lidocaine 10% (Xylocaine) spray 2 puff in one tonsillar bed; group C received bupivacaine 0.5% (Marcaine) solution 2ml in one tonsillar bed spray by syringe and the other tonsillar bed in each group receives pack with similar amounts of normal saline for 5 min as a control group after tonsillectomy before recovery from anesthesia.


There was no statistical difference between the three studied groups as regards age and sex. There is significant statistical difference according to the frequency of throat pain and ear pain by comparing cases and controls of each group within the first 24 h after surgery. It appears that increased frequency of postoperative throat pain and ear pain is present with the control side (saline).


Topical application of the tonsillar bed with a local anesthetic after tonsillectomy results in significant reduction of postoperative throat pain and referred otalgia and should be used during surgery for tonsillectomy.


  1. 1

    Lane JC, Dworkin-Valenti J, Chiodo L, Haupert M. Postoperative tonsillectomy bleeding complications in children: a comparison of three surgical techniques. Int J Pediatr Otorhinolaryngol 2016; 88:184–188.

    Article  Google Scholar 

  2. 2

    Lipman DS. Tonsillectomy techniques. Arch Otolaryngol Head Neck Surg 2005; 131:279.

    Article  Google Scholar 

  3. 3

    Tay HL. Post-operative morbidity in electrodissection tonsillectomy. J Laryngol Otol 1995; 109:209–211.

    CAS  Article  Google Scholar 

  4. 4

    Ashbach MN, Ostrower ST, Parikh SR. Tonsillectomy techniques and pain: a review of randomized controlled trials and call for standardization. ORL J Otorhinolaryngol Relat Spec 2007; 69:364–370.

    Article  Google Scholar 

  5. 5

    Cohen N, Sommer DD. Post-tonsillectomy pain control: consensus or controversy? Pain Manag 2016; 6:31–37.

    Article  Google Scholar 

  6. 6

    Gupta AK, Gupta S, Meena DS, Sharma U. Post-tonsillectomy pain: different modes of pain relief. Indian J Otolaryngol Head Neck Surg 2002; 54:136–139.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 7

    Salam MA, Cable HR. Post-tonsillectomy pain with diathermy and ligation techniques. A prospective randomized study in children and adults. Clin Otolaryngol Allied Sci 1992; 17:517–519.

    CAS  PubMed  Google Scholar 

  8. 8

    Akural EI, Koivunen PT, Teppo H, Alahuhta SM, Lopponen HJ. Post-tonsillectomy pain: a prospective, randomised and double-blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique. Anaesthesia 2001; 56:1045–1050.

    CAS  Article  Google Scholar 

  9. 9

    Atallah N, Kumar M, Hilali A, Hickey S. Post-operative pain in tonsillectomy: bipolar electrodissection technique vs dissection ligation technique. A double-blind randomized prospective trial. J Laryngol Otol 2000; 114:667–670.

    CAS  PubMed  Google Scholar 

  10. 10

    Izny Hafiz Z, Rosdan S, Mohd Khairi MD. Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain. Med J Malaysia 2014; 69:74–78.

    CAS  PubMed  Google Scholar 

  11. 11

    Elbadawey MR, Hegazy HM, Eltahan AE, Powell J. A randomised controlled trial of coblation, diode laser and cold dissection in paediatric tonsillectomy. J Laryngol Otol 2015; 129:1058–1063.

    CAS  Article  Google Scholar 

  12. 12

    Jones DT, Kenna MA, Guidi J, Huang L, Johnston PR, Licameli GR. Comparison of postoperative pain in pediatric patients undergoing coblation tonsillectomy versus cautery tonsillectomy. Otolaryngol Head Neck Surg 2011; 144:972–977.

    Article  Google Scholar 

  13. 13

    Carr MM, Muecke CJ, Sohmer B, Nasser JG, Finley GA. Comparison of postoperative pain: tonsillectomy by blunt dissection or electrocautery dissection. J Otolaryngol 2001; 30:10–14.

    CAS  Article  Google Scholar 

  14. 14

    Cook AJ, Woolf CJ, Wall PD, McMahon SB. Dynamic receptive field plasticity in rat spinal cord dorsal horn following C-primary afferent input. Nature 1987; 325:151–153.

    CAS  Article  Google Scholar 

  15. 15

    Iodice FG, Testa G. Pain relief in patients undergoing tonsillectomy. Arch Trauma Res 2013; 2:56–57.

    Article  Google Scholar 

  16. 16

    Amani S, Abedinzadeh MR. Effects of oral gabapentin, local bupivacaine and intravenous pethidine on post tonsillectomy pain. Iran J Otorhinolaryngol 2015; 27:343–348.

    PubMed  PubMed Central  Google Scholar 

  17. 17

    Akoglu E, Akkurt BC, Inanoglu K, Okuyucu S, Dagli S. Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: a randomized controlled study. Int J Pediatr Otorhinolaryngol 2006; 70:1169–1173.

    Article  Google Scholar 

  18. 18

    Afman CE, Welge JA, Steward DL. Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg 2006; 134:181–186.

    Article  Google Scholar 

  19. 19

    Ju NY, Cui GX, Gao W. Ropivacaine plus dexamethasone infiltration reduces postoperative pain after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 2013; 77:1881–1885.

    Article  Google Scholar 

  20. 20

    Kedek A, Derbent A, Uyar M, Bilgen C, Uyar M, Kirazli T, et al. Pre-emptive effects of ibuprofen syrup and lidocaine infiltration on post-operative analgesia in children undergoing adenotonsillectomy. J Int Med Res 2005; 33:188–195.

    CAS  Article  Google Scholar 

  21. 21

    Morgan GE, Mikhail MS, Murray MJ. Clinical anesthesiology. New York, USA: McGraw-Hill Education; 2005.

    Google Scholar 

  22. 22

    Malamed SF. Handbook of local anesthesia - e-book. Los Angeles, California, USA: Elsevier Health Sciences; 2014.

    Google Scholar 

  23. 23

    Somdas MA, Senturk M, Ketenci I, Erkorkmaz U, Unlu Y. Efficacy of bupivacaine for post-tonsillectomy pain: a study with the intra-individual design. Int J Pediatr Otorhinolaryngol 2004; 68:1391–1395.

    Article  Google Scholar 

  24. 24

    Honarmand A, Safavi M, Naghibi K, Attari M, Soltani M, Amoushahi M, et al. Preemptive peritonsillar infiltration with bupivacaine in combination with tramadol improves pediatric post-tonsillectomy pain better than using bupivacaine or tramadol alone: a randomized, placebo-controlled, double blind clinical trial. Adv Biomed Res 2015; 4:132.

    Article  Google Scholar 

  25. 25

    Shlizerman L, Ashkenazi D. Peripheral facial nerve paralysis after peritonsillar infiltration of bupivacaine: a case report. Am J Otolaryngol 2005; 26:406–407.

    Article  Google Scholar 

  26. 26

    Hobson JC, Malla JV, Kay NJ. Horner’s syndrome following tonsillectomy. J Laryngol Otol 2006; 120:800–801.

    CAS  Article  Google Scholar 

  27. 27

    Weksler N, Nash M, Rozentsveig V, Schwartz J, Schily M Gurman G. Vocal cord paralysis as a consequence of peritonsillar infiltration with bupivacaine. Acta Anaesthesiol Scand 2001; 45:1042–1044.

    CAS  Article  Google Scholar 

  28. 28

    Ryu HY, Kim J-Y, Lim HK, Yoon J, Yoo B-S, Choe K-H, et al. Bupivacaine induced cardiac toxicity mimicking an acute non-ST segment elevation myocardial infarction. Yonsei Med J 2007; 48:331–336.

    CAS  Article  Google Scholar 

  29. 29

    Hadzic A. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd ed. New York, USA: McGraw-Hill Education; 2017.

    Google Scholar 

  30. 30

    Abend R, Dan O, Maoz K, Raz S, Bar-Haim Y. Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety. J Behav Ther Exp Psychiatry 2014; 45:447–453.

    Article  Google Scholar 

  31. 31

    O’Leary S, Vorrath J. Postoperative bleeding after diathermy and dissection tonsillectomy. Laryngoscope 2005; 115:591–594.

    Article  Google Scholar 

  32. 32

    Erickson BK, Larson DRSt, Sauver JL, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970–2005. Otolaryngol Head Neck Surg 2009; 140:894–901.

    Article  Google Scholar 

  33. 33

    Doukumo D, Faponle A, Adenekan A, Olateju S, Bolaji B. Effects of lidocaine and k-y jellies on sore throat, cough, and hoarseness following endotracheal anaesthesia. J West Afr Coll Surg 2011; 1:44–61.

    PubMed  PubMed Central  Google Scholar 

  34. 34

    Ehsan-ul-Haq S, Udaipurwala IH, Farrukh MS. Post-tonsillectomy pain reduced by application of bupivacaine pack in the tonsillar fossa. Pak J Surg 2009; 25:76–79.

    Google Scholar 

  35. 35

    Hydri AS, Malik SM. Post-tonsillectomy pain and bupivacaine, an intra individual design study. J Coll Physicians Surg Pak 2010; 20:538–541.

    PubMed  Google Scholar 

  36. 36

    Grainger J, Saravanappa N. Local anaesthetic for post-tonsillectomy pain: a systematic review and meta-analysis. Clin Otolaryngol 2008; 33:411–419.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Pola Emad MBBCh.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

El Daly, A., El Naby, M.A. & Emad, P. Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy. Egypt J Otolaryngol 35, 173–181 (2019).

Download citation


  • anesthetics
  • local
  • pain
  • postoperative
  • tonsillectomy