A Retrospective Analysis of Superficial Cervical Plexus Blockade for Children Undergoing Otologic Surgery

Superficial cervical plexus blocks (SCPB) are well documented for anterior and lateral neck surgeries in adults. Their role in the pediatric population is less clear. Our objective was to determine whether superficial cervical plexus blockade reduced postoperative nausea and vomiting (PONV) in children undergoing otologic surgery. This single-center retrospective cohort study evaluated patients aged 1-18 years old undergoing cochlear implantation, tympanomastoidectomy, tympanoplasty, or myringoplasty via a postauricular incision over a 27-month period. Patients undergoing bilateral surgery, concurrent surgery (exclusive of myringotomy or endoscopic otologic procedures), or transcanal-only otologic procedures were excluded. The primary outcome was PONV as measured by antiemetic use or documented nausea or vomiting among patients who received a SCPB compared to patients who did not receive a block. Secondary outcomes included opioid use, length of stay in the postoperative anesthesia care unit and hospital, time to oral intake, postoperative pain scores, and adverse events. Multilinear regression analyzed the effect of independent variables on the primary outcome. Analyses were stratified by surgery type. A total of 237 patients met inclusion criteria; 121 patients (51%) received a SCPB. There was no statistically significant difference in PONV outcomes between the two groups (proportion difference 4.5%, 95% CI -7.5% to 16.5%) despite lower intraoperative opioid administration to patients in the SCPB group (intravenous morphine equivalents per kg -0.04 mg, 95% CI -0.08 to 0, p = 0.030). Addition of a SCPB did not reduce PONV for pediatric patients undergoing otologic surgery via a postauricular incision. No adverse events were attributed to the block in this study.