Effects of bupivacaine infiltration for controlling post-tonsillectomy pain: A systematic review and meta-analysis

Objective: In this study, we attempt to address these limitations and provide the current state of evidence evaluating the influence of bupivacaine during a tonsillectomy. To demonstrate the effects of bupivacaine during tonsillectomy on the visual analog scale score, mean operative procedure duration, and the onset of postoperative morbidities. Data source: A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. Review methods: A meta-analysis compared the influence of bupivacaine and normal saline administered during tonsillectomy on the visual analog scale score, duration of the operation and postoperative morbidities. Results: Out of 1,427 records, 18 articles including 729 participants (mean age: 10.2 ± 6.7 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of bupivacaine during tonsillectomy to reduce the amount of perceived level of pain, duration of the operation and postoperative morbidity as compared to normal saline. The meta-analysis reveals beneficial effects for bupivacaine interventions by demonstrating small to large effect reduction on visual analog scale score (Hedge’s g: -1.47), mean duration of operative procedure (-1.35), and incidence of postoperative morbidity (-0.23) as compared to placebo groups using normal saline. Conclusion: The current systematic review and meta-analysis recommend the administration of bupivacaine with tonsillectomy as compared to normal saline. The review reports beneficial effects of bupivacaine’s administration as compared to normal saline for reducing the perceived level of pain, duration of operation, and postoperative morbidity.