title: Topical lidocaine for postoperative analgesia following myringotomy and tube placement.
abstract: One of the most frequently performed surgical procedures in pediatrics is myringotomy and tube placement. Analgesia is often difficult to achieve and children may be uncontrollable, distressing both parents and nursing staff. We designed this investigation to determine if topical lidocaine instilled in the ear canal after myringotomy and tube placement could improve postoperative analgesia. This prospective, randomized, double-blind clinical trial compared topical 4% lidocaine combined with antibiotic drops to placebo and antibiotic drops placed in the external auditory canal following completion of myringotomy and tube placement. One hundred twenty-two ASA class I or II patients were enrolled and completed this investigation. Primary outcome measure was relief of pain based on pain scores and the need for acetaminophen. Patients who received 4% lidocaine with gentamicin had better pain scores (2.81; P = 0.002) than those receiving placebo (4.77). Twenty-seven patients (45%) in the control group received acetaminophen for treatment of postoperative pain compared to eight (13%) in the lidocaine group (P < 0.001). No reports or complaints of vertigo or tinnitus were noted in any patient. The application of 4% lidocaine in antibiotic drops significantly improves postoperative analgesia in patients undergoing myringotomy and tube insertion under general anesthesia. Utilizing this technique should help improve analgesia, specifically in the early postoperative period, and decrease the presence of stress following surgery.
authors.affiliation: Division of Pediatric Anesthesia, Arkansas Children's Hospital, Little Rock 72202-3591, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Lawhorn
authors.forename: C M
authors.initials: CM
authors.lastname: Bower
authors.forename: R E
authors.initials: RE
authors.lastname: Brown
authors.forename: M L
authors.initials: ML
authors.lastname: Schmitz
authors.forename: P J
authors.initials: PJ
authors.lastname: Kymer
authors.forename: P
authors.initials: P
authors.lastname: Volpe
authors.forename: R
authors.initials: R
authors.lastname: Shirey
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine