Dexmedetomidine with lidocaine topical anesthesia reduces emergence agitation and postoperative pain after pediatric tonsillectomy

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.