Effectiveness of peritonsillar bupivacaine versus lignocaine infiltration for post-tonsillectomy pain management in children at Kilimanjaro Christian Medical Centre: A double-blind randomized placebo-controlled superiority trial

Background: Tonsillectomy is a common pediatric procedure often paired with adenoidectomy for recurrent tonsillitis or airway obstruction. Despite surgical and anesthetic advances, postoperative pain remains a major concern. Non-steroidal anti-inflammatory drugs offer limited relief, and opioids, though effective, have notable side effects. Peritonsillar infiltration with local anesthetics like bupivacaine and lignocaine may improve pain control, but comparative data in low-resource settings are scarce. Aim: To compare the effectiveness of peritonsillar bupivacaine, lignocaine, and placebo in managing post-tonsillectomy pain in children in Tanzania. Design: A double-blind, randomized, placebo-controlled superiority trial at KCMC’s ENT Department (May 2025 to September 2025). Methods: One hundred fifty children (<18 years) undergoing elective tonsillectomy will be randomized into 3 groups receiving 0.25% bupivacaine, 2% lignocaine, or 0.45% saline infiltration. Primary outcome: pain scores. Secondary outcomes: time to normal diet, hemorrhage, need for extra analgesics, nausea/vomiting, and arrhythmias. Discussion: Results may guide pain management practices and support further research in similar low-resource settings, where data on local anesthetic efficacy remain limited.