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Perioperative pain control and tympanostomy tube outcomes
Bobbie Riley1, Kosuke Kawai2, Alexandria L Irace3
1Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
Insights
Ketorolac offers comparable pain control to fentanyl for tympanostomy tube procedures without increasing occlusion rates. This non-narcotic option is a safe alternative for pediatric pain management during ear tube surgery.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Anesthesiology
Background:
- Tympanostomy tube placement is a common pediatric surgical procedure.
- Effective perioperative pain management is crucial for patient outcomes.
- Evaluating different analgesic regimens is important for optimizing care.
Purpose of the Study:
- To assess the relationship between perioperative pain management strategies and the outcomes of tympanostomy tube procedures.
- To compare the efficacy and safety of different analgesics used during tympanostomy tube surgery.
Main Methods:
- A retrospective chart review was conducted at a tertiary referral children's hospital.
- Medical records of patients 18 years or younger who underwent tympanostomy tube placement were analyzed.
- Data collected included indications, perioperative pain medications, PACU measures, and tympanostomy tube occlusion rates.
Main Results:
- Of 455 patients, recurrent acute otitis media was the most common indication. Fentanyl was the most frequently administered intraoperative analgesic.
- No significant differences were observed in pain scores or recovery times across different intraoperative analgesia groups.
- Younger patients (≤1 year) had a higher risk of tube occlusion (23.7%) compared to older children (>1 year) (8.9%).
Conclusions:
- Ketorolac is a viable non-narcotic alternative to fentanyl for perioperative pain management in tympanostomy tube procedures.
- Ketorolac provides equivalent pain control to fentanyl and does not elevate the risk of tympanostomy tube occlusion.
- Age is a significant factor influencing tympanostomy tube occlusion rates, with younger children being at higher risk.
Objective:
To evaluate perioperative pain management regimens as they relate to tympanostomy tube outcomes.
Study Design:
Retrospective chart review.
Setting:
Tertiary referral children's hospital.
Subjects:
and Methods: The medical records of patients ≤18 years old who underwent tympanostomy tube placement were reviewed for indications, perioperative pain medications, post anesthesia recovery unit (PACU) measures, and tympanostomy tube occlusion rates.
Results:
Four hundred and fifty-five patients met inclusion criteria. Median age was 1.7 years (interquartile range: 1.2-3.3 years). Recurrent acute otitis media (n = 239, 52.5%) was the most common indication. All patients were American Society of Anesthesiologists (ASA) class 1 (n = 244, 58.1%) or 2 (n = 176, 41.9%). Fentanyl alone (n = 321, 70.6%) was the most common intraoperative analgesic administered followed by ketorolac alone (n = 40, 8.8%), and fentanyl and ketorolac together (n = 58, 12.8%). There was no significant difference in FLACC pain score at discharge and recovery time (minutes) also did not differ by intraoperative analgesia group (34.3 ± 15.2 for fentanyl; 36.2 ± 13.0 for ketorolac; 31.0 ± 12.5 for fentanyl and ketorolac together). Forty nine patients (11.6%) had an occluded tympanostomy tube at follow-up. Patients ≤1 year of age had a significantly higher risk of tube occlusion than patients >1 year of age (23.7% vs. 8.9%; p < 0.001). There was no significant difference in tube occlusion rates based on indication for tube placement, history of tube placement, intraoperative findings, or intraoperative pain regimen.
Conclusions:
Ketorolac is a reasonable non-narcotic alternative to fentanyl which provides equal pain control and does not increase tube occlusion rates.
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