Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review

Effective perioperative analgesia and control of postoperative nausea and vomiting (PONV) are key determinants of recovery after otoplasty for prominent ear deformity, yet comparative evidence for current techniques is limited.

A PROSPERO-registered systematic review (CRD42024586119) was performed in September 2024 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Google Scholar, Web of Science, and the Cochrane Library were searched (1989-2020) for English-language randomized or prospective studies reporting pain outcomes after otoplasty. Nine studies (6 randomized controlled trials and 3 cohort studies; 370 patients) met eligibility criteria. Two reviewers extracted pain scores, opioid use, PONV, and complications; risk of bias was assessed using RoB 2 and methodological index for non-randomized studies.

Regional nerve block provided superior analgesia versus local infiltration anesthesia with a mean pain score at 6 hours of 0.25 versus 2.34 (P < 0.001) and opioid requirements of 14% versus 24%. Propofol anesthesia and transdermal hyoscine patches reduced PONV to 16% versus 48% with placebo. Reported adverse events were infrequent (<5%) and transient (eg, Horner syndrome, mild bradycardia, hoarseness). Overall methodological quality was moderate, and heterogeneity precluded meta-analysis.

Regional nerve block is the most effective strategy for perioperative pain control in otoplasty, halving opioid use and improving early pain scores. Adjunctive propofol and hyoscine further reduce PONV, with no serious or lasting complications. Standardized multimodal protocols and high-quality trials-especially in pediatric and awake procedures-are required to strengthen evidence and broaden applicability.