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Bilateral glossopharyngeal nerve block with 0.2% ropivacaine reduces postoperative pain and improves recovery outcomes in pediatric tonsillectomy compared to peritonsillar infiltration or sham control

Q: What is the glossopharyngeal nerve block and how is it performed in children?

The glossopharyngeal nerve block is an injection of local anesthetic (ropivacaine) near the glossopharyngeal nerve, which supplies sensation to the tonsillar area. In this study, it was performed bilaterally under general anesthesia before the start of surgery.

Q: How does glossopharyngeal nerve block compare to peritonsillar infiltration for pain control?

In this trial, GNB provided longer-lasting pain relief (up to 24 hours for swallowing pain) and reduced nausea compared to peritonsillar infiltration with the same local anesthetic. GNB also improved sleep quality and parental satisfaction.

Q: Is glossopharyngeal nerve block safe for pediatric patients?

The study reported no serious anesthetic-related arrhythmias or bronchospasm in any group. GNB was associated with similar sedation scores to control, suggesting it is safe when performed by experienced anesthesiologists.

Q: What are the benefits of GNB beyond pain relief?

Besides lower pain scores, GNB reduced the need for rescue analgesia, decreased postoperative nausea, and improved sleep quality and parental satisfaction, which are important for recovery after tonsillectomy.

In a double-blind RCT of 90 children (4-10 years) undergoing day-case tonsillectomy, bilateral glossopharyngeal nerve block (GNB) with 0.2% ropivacaine significantly prolonged time to first analgesic request (median 240 vs 120 min for control, P<0.001) and reduced pain at rest (2-12h) and during swallowing (2-24h) compared to sham control. GNB also reduced nausea (6.7% vs 20% RI and 33.3% control) and improved sleep quality and parental satisfaction, without increased sedation or major complications.

Last updated: Aug 9, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100

Human RCT★★☆☆☆

Meta-analysis☆☆☆☆☆

Mechanism★★★★★

Safety★★★★☆

Confidencelow

Study Evidence

Study 1. Glossopharyngeal nerve block versus tonsillar fossa ropivacaine infiltration within multimodal analgesia for pediatric post-tonsillectomy pain: a randomized controlled clinical trial.

observational

Faramarzi M, Nemati M, Farbood A, Faramarzi A · European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (2026)

Participants: N/A

Duration: 24 hours post-surgery

Intervention: Bilateral glossopharyngeal nerve block (GNB) with 0.2% ropivacaine

Outcome: Postoperative pain (FLACC in PACU, FACES at rest and during swallowing), time to first analgesic request, nausea, sleep quality, parental satisfaction, adverse events

Effect Size: N/A (median difference in time to first analgesic: 120 min; pain scores lower with GNB at multiple timepoints)

Population: Children aged 4-10 years undergoing day-case tonsillectomy

Result:

PubMed: 42552476 DOI: 10.1007/s00405-026-10522-3

Mechanism Graph

Glossopharyngeal nerve block anesthetizes the sensory supply to the tonsillar fossa and posterior pharynx

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This provides targeted analgesia to the surgical site

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Reduced pain leads to lower opioid requirements and less nausea

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Improved swallowing comfort and sleep quality, and higher parental satisfaction

Limitations

⚠Single-center study with relatively small sample size (30 per group)
⚠No long-term follow-up beyond 24 hours; only immediate postoperative outcomes assessed
⚠Potential for operator-dependent variability in nerve block technique

Frequently Asked Questions

What is the glossopharyngeal nerve block and how is it performed in children?▼

The glossopharyngeal nerve block is an injection of local anesthetic (ropivacaine) near the glossopharyngeal nerve, which supplies sensation to the tonsillar area. In this study, it was performed bilaterally under general anesthesia before the start of surgery.

How does glossopharyngeal nerve block compare to peritonsillar infiltration for pain control?▼

In this trial, GNB provided longer-lasting pain relief (up to 24 hours for swallowing pain) and reduced nausea compared to peritonsillar infiltration with the same local anesthetic. GNB also improved sleep quality and parental satisfaction.

Is glossopharyngeal nerve block safe for pediatric patients?▼

The study reported no serious anesthetic-related arrhythmias or bronchospasm in any group. GNB was associated with similar sedation scores to control, suggesting it is safe when performed by experienced anesthesiologists.

What are the benefits of GNB beyond pain relief?▼

Besides lower pain scores, GNB reduced the need for rescue analgesia, decreased postoperative nausea, and improved sleep quality and parental satisfaction, which are important for recovery after tonsillectomy.

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References

1.Faramarzi M, Nemati M, Farbood A, Faramarzi A. "Glossopharyngeal nerve block versus tonsillar fossa ropivacaine infiltration within multimodal analgesia for pediatric post-tonsillectomy pain: a randomized controlled clinical trial.." European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. PMID: 42552476 DOI: 10.1007/s00405-026-10522-3

Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.