Efficacy of Levobupivacaine versus Ropivacaine for Tonsillar Pillar Block in Patients Undergoing Tonsillectomy: A Randomised Clinical Trial

Introduction: Tonsillectomy, one of the most frequent otorhinolaryngologic procedures, causes considerable pain and dysphagia in the postoperative period. As previously stated, preoperative local anaesthetic infiltration contributes to the reduction of pain during and after the surgical operation, as well as the use of postoperative analgesics. The measurement of pain intensity commonly used is the Numerical Rating Scale (NRS). Aim: To compare levobupivacaine and ropivacaine for post- tonsillectomy analgesia. Materials and Methods: This hospital-based randomised double-blinded clinical trial was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, India, between March 2023 and February 2024 on 60 American Society of Anaesthesiologists (ASA) physical status Class I and II patients aged between 7 and 25 years undergoing elective tonsillectomy undergeneral anaesthesia. Patients were randomly allocated to either the Levobupivacaine group (Group L, n=30) or the Ropivacaine group (Group R, n=30). Pain intensity in the postoperative period was measured at 15 minutes, 1 hour, 4 hours, 12 hours, and 24 hours after surgery using the NRS. Rescue analgesia was administered if the patient's pain rating exceeded five. All continuous variables were reported as mean and Standard Deviation (SD), while categorical variables were compared using the Chi-square test or Fisher's-exact test with Yates correction, wherever necessary. Results: The sample comprised 30 patients in each group. The mean ages of the participants were 16.86 and 17.55 years, respectively. The preoperative and intraoperative values of Heart Rate (HR), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were comparatively lower in the ropivacaine group. The difference between the groups was statistically insignificant. Pain scores were significantly lower in the Ropivacaine group compared to the Levobupivacaine group at 15 minutes (p-value=0.004), one hour (p-value <0.001), four hours (p-value=0.027), and 12 hours (p-value <0.001) postoperatively. By 24 hours, pain scores were similar. The need for rescue analgesia was lower in the ropivacaine group, suggesting that the duration of analgesia was longer in this group. There were no significant side-effects in either of the groups. Conclusion: The results of the study showed that patients who received ropivacaine had better postoperative pain control than those who received levobupivacaine in paediatric tonsillectomy patients. Compared to the levobupivacaine group, patients administered ropivacaine experienced reduced pain intensity at different time points and utilised fewer rescue analgesics, illustrating a prolonged and superior quality of analgesia.