intraoperative opioid administration versus intraoperative pterygopalatine ganglion block based opioid free anesthesia to compare outcomes such as postoperative administration of opioid rates of nausea and vomiting, Post Anesthesia Care Unit (PACU) length of stay

Group A ;( opioid based multimodal anesthesia) One hundred and twenty pediatric patients will do elective tonsillectomy or adenotonsillectomy surgery using opioid based multimodal anesthesia.

Group B ;( opioid free pterygopalatine ganglion block based multimodal anesthesia) One hundred and twenty pediatric patients will do elective tonsillectomy or adenotonsillectomy surgery using opioid free pterygopalatine ganglion block based multimodal anesthesia.

For each patient, intraoperative hemodynamics, additional intraoperative analgesia required, the length of PACU stay, administration of postoperative opioids, administration of postoperative non-opioid analgesics, postoperative (visual analogue score) VAS score, will be recorded.

Inclusion Criteria:

• Age 4 to 13 years old.
• Elective tonsillectomy or adenotonsillectomy surgery

Exclusion Criteria:

• Allergies to xylocaine.
• Developmental delays.
• Significant cognitive impairment.
• American Society of Anesthesiologists (ASA) Class 3 and 4.
• Patients who underwent any additional concurrent procedures such as lingual tonsillectomy.