Objective: Most studies investigating the effect of preincisional injection of local anaesthetic with adrenaline in tonsillectomy have used rather large doses and an inter-individual study design. They are inconclusive regarding the effect on post-tonsillectomy pain but have shown that the peroperative blood loss is reduced. However, side effects to high adrenaline doses are common. In the present study, the effect of injecting a small dose of lidocaine-adrenaline was investigated by using an intra-individual study design.
Methods: In this randomised double-blind study 52 patients (33 women and 19 men) received unilateral preincisional injection of 3-ml lidocaine-adrenaline before tonsillectomy.
Results: the difference in blood loss was highly significant with a more than 50% reduction in peroperative blood loss in the infiltrated side. Time to achieve haemostasis for one tonsil side was reduced from 6.0 to 4.0 min. No side effects were observed. At the operation day (mean 4.9 h after operation), the visual analogue scale for pain at the side infiltrated with local anaesthetics was 2.78 compared to 4.00 in the control side (P=0.05).
Conclusion: Low-dose injection of lidocaine-adrenaline before tonsillectomy reduces blood loss and has a small but significant beneficial effect on early postoperative pain. Furthermore our results indicate that operation time is reduced. We therefore recommend subcapsular injection of 3 ml of 1% lidocaine with 1/200.000 adrenaline under each tonsil before tonsillectomy.
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