title: Comparison of clonidine, local anesthetics, and placebo for pain reduction in pediatric tonsillectomy.
abstract: OBJECTIVE
  To determine if pretonsillectomy injection of local anesthetics with and without clonidine reduces pain following tonsillectomy in children.
  
  
  METHODS
  A prospective, randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  A total of 120 children, ages 3 to 17 years, presenting for tonsillectomy.
  
  
  METHODS
  Patients were randomized to 1 of 3 pretonsillectomy injection groups: (1) saline, (2) lidocaine plus bupivacaine, or (3) lidocaine plus bupivacaine plus clonidine.
  
  
  METHODS
  The total number of analgesic doses consumed on postoperative days (PODs) 1, 3, 5, and 7. Secondary outcome variables included total time and intravenous analgesic doses required in the recovery room, visual analog scale pain scores, and maximum tolerated diet on postoperative days 1, 3, 5, and 7.
  
  
  RESULTS
  The total number of analgesic doses on PODs 1, 3, 5, and 7 were not significantly different between the randomization groups (P = .53). The median numbers (interquartile ranges) of analgesic doses were 12.0 (9.0-16.8) for the lidocaine plus bupivacaine plus clonidine group, 12.0 (10.0-16.5) for the lidocaine plus bupivacaine group, and 14.0 (9.0-15) for the placebo group. The placebo group was found to have a more advanced diet on POD 1 (P = .04) and significantly less pain on POD 3 (P = .02). Multivariable analysis showed children in the lidocaine plus bupivacaine plus clonidine group were significantly less likely to need intravenous pain medication in the recovery room compared with children in the placebo group and again showed that the placebo group achieved a significantly more advanced diet and had less pain on PODs 1 and 3.
  
  
  CONCLUSIONS
  Pretonsillectomy injection of lidocaine, 1%, and bupivacaine, 0.5%, with or without clonidine (25 μg) is not recommended for the reduction of posttonsillectomy pain.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00678379.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA. jmoss@ceenta.com
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Moss
authors.forename: Shelagh
authors.initials: S
authors.lastname: Cofer
authors.forename: Shannon
authors.initials: S
authors.lastname: Hersey
authors.forename: Steven
authors.initials: S
authors.lastname: Goudy
authors.forename: Jay
authors.initials: J
authors.lastname: Werkhaven
authors.forename: Erik
authors.initials: E
authors.lastname: Swanson
authors.forename: Christopher
authors.initials: C
authors.lastname: Mantle
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stowell
authors.forename: Daniel
authors.initials: D
authors.lastname: Byrne
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Robert
authors.initials: R
authors.lastname: Labadie
mesh_terms: D000234:Adenoids / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000367:Age Factors; D000700:Analgesics / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000627:therapeutic use*; D003681:Dehydration / Q000209:etiology; D004032:Diet; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007267:Injections; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D014066:Palatine Tonsil / Q000473:pathology / Q000601:surgery; D011292:Premedication; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000601:surgery; D014068:Tonsillectomy; D014069:Tonsillitis / Q000601:surgery
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D008012:Lidocaine; D003000:Clonidine; D002045:Bupivacaine