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Phenol as an adjuvant anesthetic for tympanostomy tube insertion
P W Orobello1, R I Park, R C Wetzel
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Inhalational anesthesia for pediatric tympanostomy tube insertion does not relieve postoperative pain. Phenol application did not reduce pain and, unexpectedly, increased pain scores in children undergoing the procedure.
Area of Science:
- Pediatric Anesthesiology
- Otologic Surgery
- Pain Management
Background:
- Inhalational anesthesia for tympanostomy tube insertion in children lacks postoperative pain relief.
- Previous studies indicated significant postoperative cardiovascular and behavioral changes suggestive of pain.
- Phenol is used for local anesthesia in adults during this procedure.
Purpose of the Study:
- To prospectively evaluate postoperative pain in children after tympanostomy tube insertion.
- To determine if topical phenol on the tympanic membrane reduces postoperative pain.
- To measure pain using behavioral and physiological parameters.
Main Methods:
- A double-blind, randomized trial involving 46 children.
- Comparison between a phenol-treated group and a control group.
- Assessment of pain scores, blood pressure, and heart rate post-procedure.
Main Results:
- Both groups showed significant postoperative pain score elevations (P = 0.0001).
- Pain scores gradually returned to baseline within 45-60 minutes.
- The phenol group exhibited consistently higher pain scores than the control group (P < 0.001).
Conclusions:
- Topical phenol did not reduce, but rather increased, postoperative pain in children undergoing tympanostomy tube insertion.
- Further investigation is needed to understand the mechanism behind phenol's adverse effect.
- Current anesthetic protocols may require re-evaluation for pediatric tympanostomy tube procedures.
Abstract:
The use of inhalational anesthesia for insertion of tympanostomy tubes in children provides no postoperative pain relief. Our retrospective analysis of children following tympanostomy tube insertion previously had shown significant postoperative elevations of blood pressure and heart rate in over 70% of cases. These changes, along with behavioral findings and complaints of discomfort, are suggestive of pain. Phenol has been used in adults for local anesthesia during tympanostomy tube insertion. This study determined prospectively whether pain occurred postoperatively and whether phenol placed on the tympanic membrane just prior to myringotomy would reduce postoperative pain in children, as measured by behavioral and physiologic parameters. Results of a double-blind, randomized trial in 46 children showed that both the phenol-treated and the control groups demonstrated significant elevations in pain scores postoperatively (P = 0.0001), which then slowly diminished to baseline by 45 min to one hour. The phenol group had consistently higher pain scores than the non-phenol group (P less than 0.001). Possible reasons for these findings are discussed.