Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia and sedation.
CONCLUSIONS
Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia with sedation can be well tolerated by the patient, with minimum discomfort.


OBJECTIVE
To evaluate patient discomfort from pain, body/neck position, noise, and anxiety during tympanoplasties and mastoidectomies performed under local anesthesia with sedation.


METHODS
This was a prospective study of 83 surgeries in 62 patients (28 type I tympanoplasties, 12 tympanoplasties with ossicular reconstruction, 40 canal wall up mastoidectomies, and 3 revision tympanoplasties). Local infiltration used lidocaine 2% with 1:100 000 epinephrine infiltrated in the retroauricular area and from below the pinna in a 'V' pattern. Sedation was achieved with 50 mg of intramuscular promethazine 1 h before surgery and intravenous midazolam (0.03 mg/kg) at the beginning of surgery. Subsequent doses of midazolam were given to maintain adequate sedation, up to 10 mg. The discomfort during surgery was assessed by the patient with a score from 0 to 4 (0 = no discomfort and 4 = extreme discomfort).


RESULTS
Discomfort due to pain had a mean score of 0.83. Noise discomfort (from drilling and manipulation of instruments) had the lowest mean score (0.70), and discomfort from body and neck position had the highest mean score (1.51).
Sarmento
Krishnamurti Matos De Araujo
KM
Otolaryngology Department, Bonsucesso General Hospital, Rop de Janeiro, Brazil. krishnamurti.sarmento@gmail.com
Tomita
Shiro
S
D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local / Q000523:psychology; D001007:Anxiety / Q000517:prevention & control / Q000523:psychology; D002908:Chronic Disease; D016292:Procedural Sedation / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000601:surgery*; D010147:Pain Measurement / Q000523:psychology; D017060:Patient Satisfaction; D011446:Prospective Studies; D014433:Tympanoplasty / Q000379:methods* / Q000523:psychology; D055815:Young Adult