Effects of Preincisional Infiltration with Bupivacaine and Oral Dextromethorphan on Postoperative Pain in Uvulopalatopharyngoplasty / 대한이비인후과학회지

ABSTRACT

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty is one of the most painful surgical procedures in otolaryngology. Repetitive nociceptive impulses from injured peripheral tissues and activation of N-methyl-D-aspartic acid (NMDA) receptors induce central sensitization and post-injury pain hypersensitivity states. We aimed this study to evaluate whether bupivacaine for preincisional block of nociceptive afferent inputs and dextromethorphan, a clinically available NMDA receptor antagonist could reduce postoperative pain after uvulopalatopharyngoplasty. MATERIALS AND METHOD: Thirty patients scheduled for uvulopalatopharyngoplasty were randomly assigned to one of the three groups control, bupivacaine, and bupivacaine- dextromethorphan groups. The second and third group had 10 ml of 0.25% bupivacaine hydrochloride infiltrated around tonsils and soft palate before incision. The third group was given oral doses of dextromethorphan before and after surgery. Pain was assessed using numeric rating scale at rest and on swallowing on postoperative day 0, 1, 2, 3, and 5. Daily consumption of supplementary diclofenac sodium was also recorded. RESULTS: Resting pain scores were significantly lower in the groups treated with bupivacaine infiltration with or without dextromethorphan on postoperative days 0, 1, 2, 3, and 5. Swallowing pain scores were significantly lower in the bupivacaine-dextromethorphan group on days 0, 1, and 2. CONCLUSION: Preincisional infiltration with bupivacaine and oral dextromethorphan could decrease the intensity of postoperative pain following uvulupalatopharyngoplasty.