Is i.v. access necessary for myringotomy with tubes?

A retrospective chart review was conducted at a community-based hospital to determine whether intravenous access is necessary during the performance of myringotomy with tube insertion. The study included 50 pediatric patients divided equally into 2 groups: group 1, who did not have intravenous access established before the procedure, and group 2, who did have intravenous access established. To be enrolled, patients in both groups had to be < or =12 years of age, have an American Society of Anesthesiologists physical status classification of P1 or P2, and had to have undergone no adjunctive procedure with the myringotomy. Induction time was significantly shorter in group 1 (average: 6.96 +/- 2.72 minutes) than in group 2 (average: 9.80 +/- 3.82 minutes; p = 0.004). Operating time and total operating room time were not significantly different between the two groups. Additionally, 24 of 25 patients in group 1 had their pain managed with acetaminophen or no medication at all, while 9 of 25 group 2 patients received acetaminophen and 13 received intravenous pain medication. Interestingly, no patients in group 1 required antiemetics, whereas 4 patients in group 2, who were given intravenous orintramuscularnarcotics, received antiemetic medications. These findings indicate that myringotomy with tube insertion can be safely accomplished without establishing intravenous access. Induction times and time under general anesthesia were significantly increased when intravenous access was obtained. The findings also suggest that acetaminophen provides adequate postoperative pain control in this patient population and that the use of intravenous or intramuscular narcotics increases the risk of postoperative nausea.