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PALATINE NERVE BLOCK FOR TONSILLECTOMY IN ADULTS: LESS IS MORE!
ESRA Academy. Antunes C. Sep 8, 2016; 138622; 0508 Topic: REGIONAL ANAESTHESIA TECHNIQUES - BLOCK PERFORMANCE
Claudia Antunes
Claudia Antunes

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Abstract
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Background and Aims:

Analgesia for tonsillectomy in adults still representing a great challenge. The authors present five case reports of patients to whom tonsillectomy was performed under general anesthesia (GA) and bilateral palatine nerve block (BPNB).

Methods:

All patients were purposed to tonsillectomy under GA. After induction, the anesthesiologist performed BPNB, with 25G, 16 mm needle. After identifying great palatin foramen, the needle was introduced until osseous contact is felt and, afterwards, administered 0,5 to 1mL each side of levobupivacaine 0,25%. All patients receive an initial dose of 3mcg/kg fentany, iv dexamethasone 8mg and iv paracetamol 1g. In the recovery room (RR), the patient was asked about VAS pain and opioid analgesia if superior to 3. VAS was also evaluated at 24h and 1 week after surgery.

Results:

  Age Sex VAS RR Opioid dose RR VAS 24h VAS 7 days
Case 1 27 F 1/10 0 0/10 0/10
Case 2 18 F 1/10 0 1/10 1/10
Case 3 18 M 1/10 0 1/10 1/10
Case 4 40 F 1/10 0 1/10 2/10
Case 5 19 M 4/10 Morphine 2mg 2/10 3/10

Conclusions:

Tonsillectomy surgery in adults is normally associated to severe pain. These case reports shows that BPNB markedly lowers VAS, not only the immediate postoperative pain, but also maintaining lower VAS to one week after surgery. The authors suggest that the use of iv dexamethasone could extend LA effect and the block increases the long term pain threshold, so BPNB is a promising technique to pain control in tonsillectomy.

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