• An Teunkens, Kristien Vermeulen, Marleen Peters, Steffen Fieuws, Marc Van de Velde, and Steffen Rex.
• From the Department of Anaesthesiology (AT, KV, MVdV, SR), Department of Otorhinolaryngology, University Hospitals of the KU Leuven (MP), I-Biostat (SF) and Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium (MVdV, SR).
• Eur J Anaesthesiol. 2019 Mar 1; 36 (3): 206-214.

BackgroundAdenotonsillectomy is a frequently performed procedure in paediatric day-case surgery. Postoperative pain can be significant and standard analgesia protocols are often insufficient.ObjectiveOur primary objective was to investigate if infiltration of the peritonsillar space with bupivacaine would reduce the need for postoperative opioids compared with pre-emptive intravenous tramadol.DesignA double-blind, randomised controlled trial.SettingAmbulatory surgical day care centre, University Hospitals of Leuven, Belgium, from January 2012 to September 2016.PatientsTwo hundred children, between 4 and 10 years old, undergoing elective adenotonsillectomy were included in the study.InterventionChildren were randomly allocated to receive either a bolus of 3 mg kg intravenous tramadol or infiltration of the tonsillar lodge with 5-ml bupivacaine 0.25%. Reasons for exclusion were American Society of Anesthesiologists classification greater than 2, allergies to the investigated products, psychomotor retardation, bleeding disorders and lack of proficiency in Flemish.Main Outcome MeasuresThe primary endpoint was the number of children in need of piritramide postoperatively. Secondary outcomes included the cumulative dose of postoperative piritramide, pain scores and the incidence of postoperative nausea and vomiting during the first 24 postoperative hours, time to discharge and adverse effects.ResultsThe proportion of children in need of postoperative piritramide was significantly lower in the tramadol group than in children with peritonsillar infiltration (57 vs. 81%, P < 0.001). When in need of postoperative piritramide, the tramadol-group required a significantly lower dose (median [IQR] 0.7 [0.6 to 1] vs. 1 [0.6 to 1.5] mg, P < 0.007) and had lower pain scores during the first 60 min after surgery. There were no statistically significant differences in postoperative nausea and vomiting incidence, need for antiemetics or complications.ConclusionCompared with peritonsillar infiltration, preemptive intravenous tramadol decreases the need for postoperative opioids after tonsillectomy in children without increasing the incidence of side effects.Trial RegistrationEudraCT 2011-005467-25.

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