A randomized double-blind comparison of dexmedetomidine versus dexamethasone as adjuvants to levobupivacaine for peritonsillar infiltration in pediatric tonsillectomy

Background and Aims: Post-tonsillectomy pain is a primary cause of morbidity and prolonged hospital stay in children. This study compared the duration of postoperative analgesia provided by levobupivacaine with either dexmedetomidine or dexamethasone in peritonsillar infiltration. Secondary objectives were the assessment of surgeon satisfaction and side effects.Methods: Sixty American Society of Anaesthesiologists (ASA) grade I/II patients aged 4-12 years were randomized into two groups of 30. Group LD1 received peritonsillar infiltration with levobupivacaine 0.25% (2.5 ml) plus dexmedetomidine (1 mcg/kg) on each side, while Group LD2 received levobupivacaine 0.25% (2.5 ml) plus dexamethasone (0.25 mg/kg) on each side. The primary outcome was the duration of postoperative analgesia. Secondary outcomes included postoperative analgesic consumption, Wong-Baker pain scores, Ramsay sedation scores, surgeon satisfaction scores, and side effects.Results: The duration of postoperative analgesia was significantly longer in Group LD2 (14.35 ± 0.99 hours) than in Group LD1 (11.47 ± 0.81 hours). The total consumption of intravenous paracetamol in the first 24 hours post-surgery was also significantly lower in Group LD2 (345.33 ± 78.94 mg) compared to Group LD1 (428.67 ± 92.12 mg). Group LD1 demonstrated statistically significantly higher Ramsay sedation scores and surgeon satisfaction scores.Conclusion: Peritonsillar infiltration of levobupivacaine with dexamethasone provides a significantly longer duration of postoperative analgesia and reduces rescue analgesic consumption compared to levobupivacaine with dexmedetomidine. Although dexmedetomidine offers superior intraoperative conditions and sedation, dexamethasone is a more effective adjuvant for prolonging analgesia in pediatric tonsillectomy.