title: Does a preemptive block of the great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery?
abstract: We performed a double-blinded randomized controlled trial to evaluate the efficacy of preemptive analgesia in children undergoing tympanomastoid surgery. Children were divided into two groups: group block-block (BB) received a preemptive great auricular nerve block (GAN-block) with 0.25% bupivacaine with 1:200,000 epinephrine before incision followed by a second GAN-block with 0.25% bupivacaine with 1:200,000 epinephrine 1 h before the end of the procedure. Group sham block-block (SB-B) received a preemptive GAN-block with normal saline before surgical incision followed by a GAN-block with 0.25% bupivacaine with 1:200000 epinephrine 1 h before the completion of the procedure. All patients were evaluated for pain with the objective pain score (OPS) by a blinded observer. There was no difference in pain rescue requirements in the postanesthesia care unit (BB versus SB-B, 1 of 20 versus 3 of 20, P= 0.60) or in the short-stay unit (BB versus SB-B, 5 of 20 versus 11 of 20, P = 0.107) or for the entire hospital stay (P = 0.20). There was no significant difference between groups in the time to first rescue pain medication (BB versus SB-B, 226 +/- 71 min versus 201 +/- 94 min). There was no significant difference between groups regarding vomiting in the postoperative period (P = 0.52). We conclude that a preoperative GAN-block does not offer significant advantages for postoperative pain relief in children undergoing tympanomastoid surgery.
  
  
  CONCLUSIONS
  This double-blinded randomized controlled trial compared the efficacy of preemptive analgesia with a peripheral nerve block of the great auricular nerve for decreasing postoperative pain in children undergoing tympanomastoid surgery. Preemptive analgesia did not improve the quality or duration of postoperative analgesia in our cohort.
authors.affiliation: *Northwestern University Feinberg School of Medicine, the †Department of Pediatric Anesthesiology, Children's Memorial Hospital, Chicago, Illinois, and the ‡Section of Otology and Neurotology, Division of Pediatric Otolaryngology, Children's Memorial Hospital, Chicago, Illinois.
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: Corri L
authors.initials: CL
authors.lastname: Heffner
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Coté
mesh_terms: D000293:Adolescent; D000769:Anesthesia, Inhalation; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D004311:Double-Blind Method; D004432:Ear, Middle / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D009407:Nerve Block; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D010525:Peripheral Nerves; D019919:Prosthesis Implantation