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Published on: November 6, 2019
Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children
Isabelle Fournier1, Camille Caron2, C Meghan McMurtry3,4
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada.
Insights
Children undergoing tympanostomy tube insertion experienced significantly less pain with general anesthesia (GA) compared to local anesthesia (LA). Pain and distress-reducing strategies are crucial if local anesthesia is used for this common pediatric procedure.
Area of Science:
- Otolaryngology
- Pediatric Anesthesiology
- Pain Management
Background:
- Tympanostomy tube insertion (TTI) is a common pediatric procedure.
- General anesthesia (GA) is the typical anesthetic approach for TTI.
- Local anesthesia (LA) offers a potential alternative, but its efficacy in managing pain for TTI in children is less understood.
Purpose of the Study:
- To compare pain experienced by surgically naive children undergoing TTI under GA versus LA.
- To evaluate the impact of anesthesia choice on children's quality of life (QoL).
- To assess parental satisfaction with the anesthetic approach.
Main Methods:
- Prospective, single-center study comparing TTI under GA versus LA in pediatric patients.
- Pain was assessed using standardized scales (FLACC, CHEOPS) pre-procedure, during, and post-procedure.
- Quality of life (PedsQL, OM-6) and parental satisfaction were evaluated.
Main Results:
- The LA group reported significantly higher pain scores during and immediately after the procedure compared to the GA group (p < 0.01).
- No significant difference in QoL improvement or complication rates was observed between groups.
- Parental satisfaction was comparable between the GA and LA groups.
Conclusions:
- General anesthesia is associated with significantly less pain during tympanostomy tube insertion in children compared to local anesthesia.
- When considering LA for TTI, implementing robust pain and distress-reducing strategies is essential.
- Shared decision-making with families regarding anesthesia choice is critical for optimal outcomes.
Objective:
Tympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patient's quality of life (QoL) and parent's satisfaction.
Study Design:
Prospective single-center study.
Setting:
Tertiary pediatric academic center.
Methods:
Consecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC], Children's hospital of Eastern Ontario Pain Scale [CHEOPS]) were completed pre-procedure, during the first tympanostomy and second tympanostomy, and post-procedure, as well as 1 week postoperatively. General health-related QoL (PedsQL) and QoL specific to otitis media (OM-6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale.
Results:
LA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL (p > 0.05). Minor complication occurred at a similar rate (p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure (p > 0.05).
Conclusions:
Children experienced significantly less pain under GA than LA. If LA is to be used, pain and distress-reducing strategies are critical. Shared decision-making with families is essential.
Level Of Evidence:
3 Laryngoscope, 134:2422-2429, 2024.
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