Analgesic Efficacy of Peritonsillar Ropivacaine Infiltration After Tonsillectomy in Children

• Peritonsillar infiltration with ropivacaine (Other): Under general anesthesia and before surgical incision, the patient was positioned in Rose's position. Infiltration with ropivacaine was performed after intubation and before incision at three points (superior, middle, and inferior poles, including the posterior pillar), using a 23 gauge needle inserted between the pharyngeal muscles and tonsillar capsule.
• Peritonsillar infiltration with normal saline (Other): Under general anesthesia and before surgical incision, the patient was positioned in Rose's position. Infiltration with normal saline was performed after intubation and before incision at three points (superior, middle, and inferior poles, including the posterior pillar), using a 23 gauge needle inserted between the pharyngeal muscles and tonsillar capsule.
• Normal Saline (Drug): Normal saline 0.9%, 5 mL, administered (2.5 mL per tonsillar bed)
• ropivacaine (local infiltration) (Drug): Ropivacaine 0.2%, 5 mL, administered (2.5 mL per tonsillar bed)

Primary outcomes

• Time to first postoperative analgesic request [From the end of surgery until 24 hours postoperatively]: Time from the end of surgery to the first administration of rescue analgesic medication. The time was recorded in hours.

Secondary outcomes

• Intraoperative remifentanil dose (µg) [Perioperative.]: It refers to the total dose of remifentanil administered to the patient during the entire surgical procedure. It reflects the amount of opioid used for intraoperative analgesia.
• Paracetamol Consumption at 24h [In the first 24 hours postoperatively]: It refers to the total dose of paracetamol consumed in the first 24 hours postoperatively, normalized per kilogram of body weight (mg/kg).
• Time to first oral intake [From the end of surgery until first oral intake, assessed during the first 24 hours after surgery.]: Time from the end of surgery to the first oral intake, expressed in hours.
• Face, Legs, Activity, Cry, Consolability scores over 24h [At 0, 2, 4, 8, 12 and 24 hours after surgery]: Postoperative pain intensity assessed using the Face, Legs, Activity, Cry, Consolability scale (FLACC), ranging from 0 (no pain) to 10 (worst possible pain).
• Parental satisfaction [At 24 hours after surgery]: Parents' satisfaction was assessed using a 5-point Likert scale, where 1 indicated very dissatisfied, 5 very satisfied.
• Incidence of adverse effects [Perioperative.]: Occurrence of adverse effects (hypotension, bradycardia, arrhythmia, or local anesthetic toxicity) during or after surgery.
• Need for rescue tramadol [Perioperative.]: Once the FLACC score will be ≥ 4, rescue analgesia in the form of tramadol will be given.
• Surgical conditions [Perioperative.]: It refers to the surgical dissection evaluated by the surgeon, easy, moderately easy or hard.
• Intraoperative systolic blood pressure [Perioperative.]: It refers to the the systolic blood pressure collected intraoperatively every ten minutes.
• Intraoperative diastolic blood pressure. [Perioperative.]: It refers to the diastolic blood pressure collected intraoperatively every ten minutes.
• Intraoperative heart rate [Perioperative.]: It refers to the heart rate collected intraoperatively every ten minutes.

Sex: All, ages: 3 Years to 6 Years

Inclusion Criteria:

* Children aged 3-6 years
* classified as ASA I-II
* scheduled for elective tonsillectomy without adenoidectomy

Exclusion Criteria:

* systemic diseases (hepatic, renal, hematologic, or cardiac)
* obesity (BMI ≥ 95th percentile)
* upper respiratory infection within two weeks
* chronic analgesic use
* known allergy to local anesthetics