title: Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial.
abstract: OBJECTIVE
  Acute otitis media (AOM) is common in children, yet the optimal management of ear pain associated with AOM has not been well studied. We set out to determine the efficacy of topical aqueous 2% lignocaine eardrops compared with a placebo (saline) for pain relief of AOM in children.
  
  
  METHODS
  Double-blind, randomised, placebo-controlled trial.
  
  
  METHODS
  Tertiary children's hospital emergency department.
  
  
  METHODS
  Children aged between 3 and 17 years with earache and AOM without evidence of perforation were eligible. Patients were randomised to receive either 2% lignocaine or saline eardrops (placebo).
  
  
  METHODS
  Pain scores were measured before and after ear-drop administration. Patient and physician-interpreted pain scores were measured by using the Bieri faces pain scale and visual analogue scale at 10, 20 and 30 minutes. The primary outcome measure was reduction in patient-measured pain scores by 50% from the baseline. Secondary outcome measures were reduction in patient-measured pain scores by 25% or by at least two points. Telephone follow-up occurred after 1 day and 1 week. Analysis was by intention to treat.
  
  
  RESULTS
  63 children (31 were treated with lignocaine, 32 with placebo) aged 3 to 12 years were enrolled. The groups were demographically and clinically similar, with similar proportions having received analgesia in the preceding 4 hours. Children receiving lignocaine showed significantly lower patient-measured pain scores with a reduction by 50% from baseline at 10 minutes (RR 2.06, 95% CI 1.03-4.11, p = 0.03) and 30 minutes (RR 1.44, 95% CI 1.07-1.93, p = 0.009) but not at 20 minutes (RR 1.35 95% CI 0.88-2.06). The response to lignocaine treatment showed significantly lower patient-measured pain scores for 25% reduction at all time points and for two-point reduction at 10 minutes and favoured lignocaine at 20 minutes and 30 minutes without reaching statistical significance. There were no serious adverse events during the 30 minute follow-up period.
  
  
  CONCLUSIONS
  This study suggests that topical aqueous 2% lignocaine eardrops provide rapid relief for many young children presenting with ear pain attributed to AOM. The concurrent use of simple oral analgesia is a likely contributor to effective management of this painful childhood condition.
authors.affiliation: Emergency Department, Royal Children's Hospital, Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Bolt
authors.forename: Peter
authors.initials: P
authors.lastname: Barnett
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Sharwood
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D000293:Adolescent; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D010033:Otitis Media / Q000188:drug therapy*; D010147:Pain Measurement; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine