title: Postoperative pain relief in children undergoing tympanomastoid surgery: is a regional block better than opioids?
abstract: Peripheral nerve blocks of the surgical site can reduce the need for perioperative opioids thereby decreasing their unwanted adverse effects, such as postoperative nausea and vomiting. In this prospective, randomized, double-blinded study, we examined the efficacy of a great auricular nerve (GAN) block compared with IV morphine sulfate in children undergoing tympanomastoid surgery. After the induction of general anesthesia, children were randomized to receive either a GAN block with 2 mL of 0.25% bupivacaine with epinephrine (1:200,000) and a sham IV injection of 2 mL of saline solution or a sham GAN block with 2 mL of saline solution with an IV injection of 0.1 mg/kg morphine sulfate diluted to 2 mL. Patients' objective pain scores were assessed by a blinded observer and the incidence of vomiting was recorded. The GAN-Block patients as a group required more pain rescue in the postanesthesia care unit; this difference was not statistically different from the IV-morphine group (P = 0.084). Nine GAN-Block patients never received opioid or other analgesics at any time in the first 24 h after surgery. The group that received the GAN block also had a less frequent incidence of vomiting requiring intervention (7 versus 19) during their entire hospitalization or at home (P = 0.027). The GAN-Block group also had more patients who never experienced vomiting (13 of 20 versus 5 of 20, P = 0.026). In this cohort, a peripheral nerve block decreased the overall incidence of postoperative vomiting thereby reducing associated costs.
  
  
  CONCLUSIONS
  We prospectively compared the use of a great auricular nerve block versus IV morphine sulfate in a randomized double-blinded study in children undergoing tympanomastoid surgery. Analgesia was comparable between groups but nearly half the Block group never required additional analgesics and the number of vomiting events was nearly 66% less.
authors.affiliation: Department of Pediatric Anesthesiology and Division of Otolaryngology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA. ssureth@northwestern.edu
authors.forename: Santhanam
authors.initials: S
authors.lastname: Suresh
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Barcelona
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Young
authors.forename: Ilana
authors.initials: I
authors.lastname: Seligman
authors.forename: Corri L
authors.initials: CL
authors.lastname: Heffner
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Coté
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007275:Injections, Intravenous; D008416:Mastoid / Q000601:surgery*; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011446:Prospective Studies; D014432:Tympanic Membrane / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine