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Do children undergoing bilateral myringotomy with placement of ventilating tubes benefit from pre-operative analgesia? A double-blinded, randomised, placebo-controlled trial

Published online by Cambridge University Press:  12 July 2018

B McHale ,
C D Badenhorst ,
C Low  and
D Blundell
B McHale
Affiliation:
Department of General Medicine, Rotorua Hospital, New Zealand
C D Badenhorst*
Affiliation:
Department of Anaesthesia, Wellington Hospital, New Zealand
C Low
Affiliation:
Department of Otolaryngology, Tauranga Hospital, New Zealand
D Blundell
Affiliation:
Department of Anaesthesia, Rotorua Hospital, New Zealand
*
Author for correspondence: Dr Christopher Badenhorst, 88 South Karori Road, Karori, Wellington 6012, New Zealand E-mail: chrisdean584@gmail.com
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Abstract

Objective

A double-blinded, randomised, placebo-controlled trial was conducted to determine whether routine pre-operative analgesia is beneficial in reducing post-operative ear pain following bilateral myringotomy and tube placement.

Methods

Forty-five children (aged 3–15 years) were randomised to receive either pre-operative analgesics (paracetamol and ibuprofen) (n = 21) or placebo (n = 24). All children underwent sevoflurane gas induction with intranasal fentanyl (2 mcg/kg) to reduce the incidence of emergence agitation. Post-operative pain scores were measured using the Wong-Baker Faces Pain Rating Scale. Median pain scores taken 90 minutes post-surgery, and the highest pain score recorded prior to 90 minutes, were analysed.

Results

There were no statistical differences between the median pain scores at 90 minutes or subsequent need for rescue analgesia. Emergence agitation did not occur in any child. Inadvertent ear trauma, use of an intravenous cannula or airway adjunct did not affect pain scores.

Conclusion

Routine pre-operative analgesia does not reduce pain scores in the early post-operative period. Simple analgesics are effective for rescue analgesia in the minority of cases.

Keywords

ChildAnesthesiaPainPain ManagementAnalgesiaAcetaminophenIbuprofenFentanylEmergence DeliriumMiddle Ear Ventilation
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 685 - 692
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr C Badenhorst takes responsibility for the integrity of the content of the paper

Presented at the 67th Annual General and Scientific Meeting of New Zealand Otolaryngology and Head and Neck Surgery, 13–16 October 2014, Rotorua, New Zealand.

References

1Tobias, J, Lowe, S, Hersey, S, Rasmussen, GE, Werkhaven, J. Analgesia after bilateral myringotomy and placement of pressure equalization tubes in children: acetaminophen versus acetaminophen with codeine. Anesth Analg 1995;81:496–500Google Scholar
2Watcha, M, Ramirez-Ruiz, M, White, P, Jones, M, Lagueruela, R, Terkonda, R. Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth 1992;39:649–54Google Scholar
3Orobello, P, Park, R, Wetzel, R, Belcher, L, Naclerio, R. Phenol as an adjuvant anesthetic for tympanostomy tube insertion. Int J Pediatr Otorhinolaryngol 1991;21:51–8Google Scholar
4Hoffman, R, Li, C. Tetracaine topical anesthesia for myringotomy. Laryngoscope 2001;111:1636–8Google Scholar
5Bennie, R, Boehringer, L, McMahon, S, Allen, H, Dierdorf, S. Postoperative analgesia with preoperative oral ibuprofen or acetaminophen in children undergoing myringotomy. Paediatr Anaesth 1997;7:399–403Google Scholar
6Ragg, P, Davidson, A. Comparison of the efficacy of paracetamol versus paracetamol, codeine and promethazine (Painstop) for premedication and analgesia for myringotomy in children. Anaesth Intensive Care 1997;25:29–32Google Scholar
7Derkay, C, Wadsworth, J, Darrow, D, Strasnick, B, Thompson, G, O'Master, J. Tube placement: a prospective, randomized double-blind study. Laryngoscope 1998;108:97–101Google Scholar
8Bolton, P, Bridge, H, Montgomery, C. The analgesic efficacy of preoperative high dose (40 mg/kg) oral paracetamol after bilateral myringotomy and grommet insertion in toddlers. Paediatr Anaesth 2000;10:687–705Google Scholar
9Pappas, L, Fluder, E, Creech, S, Hotaling, A, Park, A. Postoperative analgesia in children undergoing myringotomy and placement equalisation tubes in ambulatory surgery. Anesth Analg 2003;96:1621–4Google Scholar
10Bhananker, S, Azavedo, L, MacCormick, J, Splinter, W. Topical lidocaine and oral acetaminophen provide similar analgesia for myringotomy and tube placement in children. Can J Anaesth 2006;53:1111–16Google Scholar
11Rampersad, S, Jimenez, N, Bradford, H, Seidel, K, Lynn, A. Two agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery. Paediatr Anaesth 2010;20:1028–35Google Scholar
12Beyer, J, McGrath, P, Berde, C. Discordance between self-report and behavioral pain measures in children aged 3-7 years after surgery. J Pain Symptom Manage 1990;5:350–6Google Scholar
13Finkel, J, Cohen, I, Hannallah, R, Patel, K, Kim, S, Hummer, K et al. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg 2001;92:1164–8Google Scholar
14Kuratani, N, Oi, Y. Greater incidence of emergence agitation in children after sevoflurane anesthesia as compared with halothane: a meta-analysis of randomised controlled trials. Anesthesiology 2008;109:225–32Google Scholar
15Wong-Baker FACES Foundation. Wong-Baker FACES® Pain Rating Scale. In: http://wongbakerfaces.org/ [7 June 2018]Google Scholar
16Bajwa, S, Costi, D, Cyna, A. A comparison of emergence delirium scales following general anesthesia in children. Pediatr Anaesth 2010;20:704–11Google Scholar
17Heintze, K, Fuchs, W. Codeine ultra-rapid metabolizers: age appears to be a key factor in adverse effects of codeine. Drug Res (Stuttg) 2015;65:640–4Google Scholar
18Perrott, D, Piira, T, Goodenough, B, Champion, D. Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: a meta-analysis. Arch Pediatr Adolesc Med 2004;158:521–6Google Scholar
19Derry, C, Derry, S, Moore, R. Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Cochrane Database Syst Rev 2013;(6):CD010210Google Scholar
20Galinkin, J, Fazi, L, Romulo, C, Chiavicci, R, Kurth, D, Shah, U et al. Use of intranasal fentanyl in children undergoing myringotomy and tube placement during halothane and sevoflurane anesthesia. Anesthesiology 2000;93:1378–83Google Scholar
21Wells, L, Rasch, D. Emergence ‘delirium’ after sevoflurane anesthesia: a paranoid delusion? Anesth Analg 1999;88:1308–10Google Scholar
22Cohen, I, Hannallah, R, Hummer, K. The incidence of emergence agitation associated with desflurane anesthesia in children is reduced by fentanyl. Anesth Analg 2001;93:88–91Google Scholar
23Voepel-Lewis, T, Malviya, S, Tait, A. A prospective cohort study of emergence agitation in the pediatric postanaesthesia care unit. Anesth Analg 2003;96:1625–30Google Scholar
24Dahmani, S, Stanyl, I, Brasher, C, Lejeune, C, Bruneau, B, Wood, C et al. Pharmacological prevention of sevoflurane and desflurane related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth 2010;104:216–23Google Scholar
25Dewhirst, E, Fedel, G, Raman, V, Rice, J, Barry, N, Jatana, K et al. Pain management following myringotomy and tube placement: intranasal dexemedetomidine versus intranasal fentanyl. Int J Pediatr Otorhinolaryngol 2014;78:1090–4Google Scholar
26Shi, F, Xiao, Y, Xiong, W, Zhou, Q, Yang, P, Huang, X. Effects of fentanyl on emergence agitation in children under sevoflurane anesthesia: meta-analysis of random controlled trials. PloS One 2015;10:e0135244Google Scholar
27Cravero, J, Beach, M, Thyr, B, Whalen, K. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg 2003;97:364–7Google Scholar
28Rampersad, S, Jimenez, N, Bradford, H, Seidel, K, Lynn, A. Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery. Paediatr Anaesth 2010;20:1028–35Google Scholar
29Foster, D, Upton, R, Christrup, L, Popper, L. Pharmacokinetics and pharmacodynamics of intranasal versus intravenous fentanyl in patients with pain after oral surgery. Ann Pharmacother 2008;42:1380–7Google Scholar
30Christrup, L, Foster, D, Popper, L, Troen, T, Upton, R. Pharmacokinetics, efficacy, and tolerability of fentanyl following intranasal versus intravenous administration in adults undergoing third-molar extraction: a randomized, double-blind, double-dummy, two-way, crossover study. Clin Ther 2008;30:469–81Google Scholar
31Panagiotou, I, Mystakidou, K. Intranasal fentanyl: from pharmacokinetics and bioavailability to current treatment applications. Expert Rev Anticancer Ther 2010;10:1009–21Google Scholar
32Cote, C, Lerman, J, Anderson, B. Practice of Anesthesia for Infants and Children, 5th edn. Philadelphia: Elsevier Saunders, 2012Google Scholar
33Gourlay, G, Kowalski, S, Plummer, J, Cousins, M, Armstrong, P. Fentanyl blood concentration-analgesic response relationship in the treatment of postoperative pain. Anesth Analg 1988;67:329–37Google Scholar
34World Health Organization. WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses. Geneva: World Health Organization, 2012Google Scholar
35Haupert, M, Pascual, C, Mohan, A, Bartecka-Skrzypek, B, Zestos, M. Parental satisfaction with anesthesia without intravenous access for myringotomy. Arch Otolaryngol Head Neck Surg 2004;130:1025–8Google Scholar