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Postoperative analgesia in children undergoing myringotomy and placement equalization tubes in ambulatory surgery
Ana Lucia Pappas1, Elaine M Fluder, Steve Creech
1*Department of Anesthesiology, †Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois.
Insights
Ketorolac administered intramuscularly was the most effective pain reliever for children undergoing myringotomy with tube placement. This analgesic provided longer pain relief and fewer side effects compared to other options.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Myringotomy with tube placement is a common pediatric surgical procedure.
- Effective pain management is crucial for optimizing recovery and patient comfort post-procedure.
Purpose of the Study:
- To compare the efficacy and safety of four different analgesic regimens in children undergoing bilateral myringotomy and tube placement.
- To identify the optimal analgesic strategy for post-myringotomy pain management in pediatric patients.
Main Methods:
- A prospective, randomized, observer-blinded study involving 120 children.
- Four groups received different analgesics: acetaminophen, acetaminophen with codeine, transnasal butorphanol, or intramuscular ketorolac.
- Pain and behavior were assessed using validated scales, with rescue medication administered as needed.
Main Results:
- Intramuscular ketorolac demonstrated the longest time to first rescue analgesic.
- Ketorolac and butorphanol provided superior analgesia compared to acetaminophen-based regimens.
- Children receiving ketorolac experienced less postoperative vomiting and nausea compared to butorphanol.
Conclusions:
- Intramuscular ketorolac is a highly promising analgesic for pain management after myringotomy and tube placement in children.
- Ketorolac offers superior pain control and a favorable side effect profile in this surgical population.
- Both ketorolac and butorphanol are effective alternatives to acetaminophen-based analgesia for pediatric myringotomy.
Unlabelled:
We enrolled 120 children undergoing bilateral myringotomy and tube placement in this prospective, randomized, observer-blinded study. Patients were randomized into one of four groups: Group 1 (control) was plain acetaminophen 10 mg/kg orally, Group 2 was acetaminophen 10 mg/kg with 1 mg/kg of codeine orally, Group 3 was transnasal butorphanol 25 micro g/kg given immediately after the induction of anesthesia, and Group 4 was ketorolac 1 mg/kg given IM immediately after the induction of anesthesia. All children received oral midazolam (0.6 mg/kg) before surgery. A nurse blinded to the analgesic technique used assessed the child's behavior at the induction of anesthesia and in the postanesthesia care unit using a 4-point scale. Analgesic effectiveness was determined by assessing the child's pain at 5-min intervals using a modified 10-point objective pain scale. In the postanesthesia care unit, rescue pain medication was administered for an objective pain scale >or=4 or a behavior score >or=3. Our data suggest that IM ketorolac is a promising analgesic to be used in this surgical population. Time to first rescue analgesic was longest in the ketorolac group, and there was no associated postoperative vomiting or nausea. IM ketorolac given during surgery was the best analgesic regimen for these procedures.
Implications:
We compared four different analgesics in the management of pain after placement of pressure equalization tubes during myringotomy in children and demonstrated that ketorolac or butorphanol provided superior analgesia when compared with acetaminophen with codeine or plain acetaminophen. Children who received ketorolac versus butorphanol had less vomiting in the 24 h after surgery.