Abstract
Tonsillectomy is among the most frequently performed surgical procedures in pediatric patients. The incidence of postoperative pain in children after tonsillectomy is high. Patient age and postoperative pain are significant factors that increase the incidence of emergence agitation in children. The study aims to evaluate the impact of spraying dexmedetomidine and lidocaine on the bilateral tonsillar fossa before tonsillectomy on postoperative pain and agitation in children. A total of 140 children aged 4–12 years, who underwent elective tonsillectomy were randomly assigned to four groups: Group N received 5 ml of normal saline, Group L received 5 ml of 2%lidocaine(2 mg/kg) plus saline, Group D received 5 ml of 2 µg/kg dexmedetomidine plus saline, and Group LD received 5 ml of 2 µg/kg dexmedetomidine plus 2 mg/kg 2%lidocaine plus saline. These solutions were applied to the bilateral tonsillar fossa 3 min before surgical incision, following intubation and under general anesthesia. Heart rate and mean arterial pressure were monitored at six time points: upon entering the room(T0),start of operation(T1),end of operation(T2),5 min after extubation (T3),10 min after extubation (T4),and 20 min after extubation (T5).Restlessness was assessed using the Pediatric Anesthesia Emergence Delirium scale at T3, T4, and T5.Postoperative pain was evaluated with the FLACC(Face, Legs, Activity, Cry, Consolability) scale at T3, T4, T5, one hour (T6), and six hours (T7) post-extubation. Anesthetic drug dosage, extubation time, sinus bradycardia, respiratory adverse events, nausea, vomiting, and reoperation for hemostasis within 24 h were documented. Dexmedetomidine groups (D and LD) exhibited reduced agitation and pain compared to non-dexmedetomidine groups (N and L) (P < 0.05), and required less anesthesia during surgery (P < 0.05). Lidocaine did not alleviate postoperative pain or agitation (P > 0.05). Dexmedetomidine slightly decreased heart rate and mean arterial pressure (P < 0.05), but without clinical significance. No differences were observed in operation duration, PACU stay, postoperative nausea/vomiting, or respiratory events among all groups (P > 0.05). In summary, preoperative tonsillar spraying of dexmedetomidine contributes to reduced emergence agitation and postoperative pain in pediatric patients undergoing tonsillectomy.But spraying lidocaine doesn’t help with that.
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Data availability
The data are available from the corresponding author after a reasonable request.
Abbreviations
- PACU:
-
Postanesthesia care unit
- BMI:
-
Body mass index
- PAED:
-
Pediatric anesthesia emergence delirium
- FLACC:
-
The face, legs, activity, cry, consolability behavioral tool
References
Sampaio, A. L., Pinheiro, T. G., Furtado, P. L., Araújo, M. F. & Olivieira, C. A. Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate. Int. J. Pediatr. Otorhinolaryngol. 71(4), 645–651 (2007).
Stewart, D. W., Ragg, P. G., Sheppard, S. & Chalkiadis, G. A. The severity and duration of postoperative pain and analgesia requirements in children after tonsillectomy, orchidopexy, or inguinal hernia repair. Paediatr. Anaesth. 22(2), 136–143 (2012).
Loeser, J. D. & Melzack, R. Pain: An overview. The Lancet 353(9164), 1607–1609 (1999).
Dahmani, S., Delivet, H. & Hilly, J. Emergence delirium in children: An update. Curr. Opin. Anaesthesiol. 27(3), 309–315 (2014).
Lee, S. J. & Sung, T. Y. Emergence agitation: Current knowledge and unresolved questions. Korean J. Anesthesiol. 73(6), 471–485 (2020).
Cho, H. K., Yoon, H. Y., Jin, H. J. & Hwang, S. H. Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis. Laryngoscope 128(5), E184–E193 (2018).
Bloor, B. C., Ward, D. S., Belleville, J. P. & Maze, M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 77(6), 1134–1142 (1992).
Shen, F. et al. Effect of intranasal dexmedetomidine or midazolam for premedication on the occurrence of respiratory adverse events in children undergoing tonsillectomy and adenoidectomy: A randomized clinical trial. JAMA Netw. Open 5(8), e2225473 (2022).
Anttila, M., Penttilä, J., Helminen, A., Vuorilehto, L. & Scheinin, H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br. J. Clin. Pharmacol. 56(6), 691–693 (2003).
Abdel-Ghaffar HS, Abdel-Wahab AH, Roushdy MM. Dexmedetomidina transmucosa oral para controle da agitação ao despertar em crianças submetidas a amigdalectomia: ensaio clínico randomizado [Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial]. Braz J Anesthesiol. 69(5):469-476 (2019)
Shen, F. et al. Effect of intranasal dexmedetomidine or midazolam for premedication on the occurrence of respiratory adverse events in children undergoing tonsillectomy and adenoidectomy: A randomized clinical trial. JAMA Netw Open. 5(8), e2225473 (2022).
Chen, Z., Liu, Z., Feng, C., Jin, Y. & Zhao, X. Dexmedetomidine as an adjuvant in peripheral nerve block. Drug Des. Devel. Ther. 17, 1463–1484 (2023).
Rwei, A. Y., Sherburne, R. T., Zurakowski, D., Wang, B. & Kohane, D. S. Prolonged duration local anesthesia using liposomal bupivacaine combined with liposomal dexamethasone and dexmedetomidine. Anesth. Analg. 126(4), 1170–1175 (2018).
Hosseini Jahromi, S. A., Hosseini Valami, S. M. & Hatamian, S. Comparison between effect of lidocaine, morphine and ketamine spray on post-tonsillectomy pain in children. Anesth. Pain Med. 2(1), 17–21 (2012).
Meechan, J. G. Intra-oral topical anaesthetics: A review. J. Dent. 28(1), 3–14 (2000).
Goudarzi, T. H., Kamali, A., Yazdi, B. & Broujerdi, G. N. Addition of dexmedetomidine, tramadol and neostigmine to lidocaine 1.5% increasing the duration of postoperative analgesia in the lower abdominal pain surgery among children: A double-blinded randomized clinical study. Med. Gas Res. 9(3), 110–114 (2019).
Lu, Y. et al. Perineural dexmedetomidine as an adjuvant reduces the median effective concentration of lidocaine for obturator nerve blocking: A double-blinded randomized controlled trial. PLoS ONE 11(6), e0158226 (2016).
Sikich, N. & Lerman, J. Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology 100(5), 1138–1145 (2004).
Peng, T. et al. A systematic review of the measurement properties of face, legs, activity, cry and consolability scale for pediatric pain assessment. J. Pain Res. 16, 1185–1196 (2023).
Walker, T. & Kudchadkar, S. R. Pain and sedation management: 2018 update for the Rogers’ textbook of pediatric intensive care. Pediatr. Crit. Care Med. 20(1), 54–61 (2019).
Cruickshank, M. et al. Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: A systematic review. Health Technol Assess. 20(25), v–117 (2016).
Simonini, A. et al. Dexmedetomidine reduced the severity of emergence delirium and respiratory complications, but increased intraoperative hypotension in children underwent tonsillectomy: A retrospective analysis. Minerva Pediatr. (Torino). 76(5), 574–581 (2024).
Mikami, M. et al. Dexmedetomidine’s inhibitory effects on acetylcholine release from cholinergic nerves in guinea pig trachea: A mechanism that accounts for its clinical benefit during airway irritation. BMC Anesthesiol. 17(1), 52 (2017).
Tang, C. et al. Intranasal dexmedetomidine on stress hormones, inflammatory markers, and postoperative analgesia after functional endoscopic sinus surgery. Mediators Inflamm. 2015, 939431 (2015).
Gong, M., Man, Y. & Fu, Q. Incidence of bradycardia in pediatric patients receiving dexmedetomidine anesthesia: A meta-analysis. Int J Clin Pharm. 39(1), 139–147 (2017).
Tobias, J. D. Dexmedetomidine: Applications in pediatric critical care and pediatric anesthesiology. Pediatr. Crit Care Med. 8(2), 115–131 (2007).
Tasbihgou, S. R., Barends, C. R. M. & Absalom, A. R. The role of dexmedetomidine in neurosurgery. Best Pract. Res. Clin. Anaesthesiol. 35(2), 221–229 (2021).
Richa, F. & Yazigi, A. Effect of dexmedetomidine on blood pressure and bleeding in maxillo-facial surgery. Eur. J. Anaesthesiol. 24(11), 985–986 (2007).
Yi, X., Deng, T., Zhu, H. & Fu, Y. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 36(10), 768–771 (2022).
Acknowledgements
The First Affiliated Hospital of Gannan Medical University Department of Anesthesiology all personnel.
Funding
This article is supported by the following funds: Jiangxi Provincial Natural Science Foundation (Grant No. 20232ACB206050) 、The Open Project of Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Disease, Ministry of Education (Grant No. XN201917) and Science 、Technology Plan Guidance Tasks of Ganzhou City (Grant No. GZ2020ZSF079) and Commissioned Research Project Contract of Gannan Medical University (Grant No. HX202204).
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C.L., L.H.B. and D.X.J.: conceived and designed the study. L.H.B. and Y.W.Y.: conducted the study. L.H.B., Z.T. and L.X.: analyzed the data. L.H.B. and Z.T.: prepared the first draft of the manuscript. L.H.B., L.X., L.Z.L., Z.T., Z.M.L. and L.W.D.: contributed to the major revision of the manuscript. All authors contributed to the final manuscript revisions and approved the final version.
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The trial obtained approved by the ethics review committee of the First Affiliated Hospital of Gannan Medical University (ethics number: LLSC-2023042601) and registered in the China clinical trial registry (ChiCTR2300072611). The study was conducted according to the tenets of the Declaration of Helsinki for medical research involving human subjects.
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Liu, HB., Zheng, T., Zhong, ML. et al. Dexmedetomidine with lidocaine topical anesthesia reduces emergence agitation and postoperative pain after pediatric tonsillectomy. Sci Rep (2026). https://doi.org/10.1038/s41598-025-34802-w
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DOI: https://doi.org/10.1038/s41598-025-34802-w
