Ropivacaine with or without clonidine improves pediatric tonsillectomy pain

Objective: To determine if preemptive analgesia with ropivacaine hydrochloride with or without clonidine hydrochloride decreases pain and hastens recovery after tonsillectomy. Design: Prospective, randomized, triple-blinded trial. Setting: University referral center; pediatric ambulatory practice. Participants: Sixty-four children, aged 3 to 15 years, undergoing tonsillectomy. Interventions: Patients received injections in the tonsillar fossae of isotonic sodium chloride, ropivacaine, or ropivacaine plus clonidine prior to tonsil excision. Main Outcome Measures: Visual analogue (pain) scale scores at rest and when drinking, opioid use, recovery time to normal activity, and incidence of symptoms such as otalgia. Results: Pain was reduced on postoperative day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups as compared with the isotonic sodium chloride-treated group (P < .05). Pain was also decreased in the ropivacaine plus clonidine-treated group on postoperative days 3 and 5 (P < .05). Intravenous narcotic use was decreased on day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups (P < .05). Cumulative codeine use was similar at day 3 for all patients, but was decreased at day 5 in the ropivacaine plus clonidine-treated group (P < .05). The incidence of otalgia decreased from 89% (16/18) in the isotonic sodium chloride-treated group to 63% (12/19) in the ropivacaine-treated and 61%(11/18) in the ropivacaine plus clonidine-treated groups (P < .01). Recovery to normal activity was shortened from 8.1 <plus/minus> 1.6 days to 5.8 +/- 2.9 days (mean +/- SD) in the isotonic sodium chloride-treated and ropivacaine plus clonidine-treated groups, respectively (P = .03). Conclusion: Preincisional injection of ropivacaine with clonidine prior to tonsillectomy has a preemptive analgesic effect that outlasts the local anesthetic and decreases pain, opioid use, and the time to return to normal activity.