Topical lidocaine and oral acetaminophen provide similar analgesia for myringotomy and tube placement in children

Bhananker, Sanjay M.; Azavedo, Lawrence; Splinter, William M.; MacCormick, Johnna

doi:10.1007/bf03022879

Cited by 19 publications

(22 citation statements)

References 18 publications

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“…Thirteen studies investigated the optimization of perioperative pain management for myringotomy and tympanostomy (MT) procedures (Table ) . Pain was scored using a variety of methods; four studies employed the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), two studies utilized the Face, Legs, Activity, Cry, Consolability (FLACC) scale, one study used the Children's and Infant's Postoperative Pain Scale, one study used the Wong‐Baker FACES Pain Rating Scale (WBS), one study used the visual analog scale (VAS), and the remaining four studies used objective pain scales (OPS).…”

Section: Resultsmentioning

confidence: 99%

Perioperative analgesia for patients undergoing otologic surgery: An evidence‐based review

et al. 2019

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Objectives/Hypothesis Opioid misuse and diversion is a major concern, with a negative impact on both the individual and society. The objective of this study was to perform an evidence‐based systematic review of the efficacy of perioperative analgesic regimens following otologic surgery. Methods Embase, Cochrane Library, and PubMed/MEDLINE databases (January 1, 1947 to June 30, 2018) were searched for studies investigating pain management in otologic surgeries. All studies were assessed for quality and bias using the Cochrane bias tool. Patient demographics, type of surgery, medication class, dose, administration characteristics, pain scores, and adverse events were reported. Results Twenty‐three studies encompassing 1,842 patients met inclusion criteria. In 21.4% of studies, an overall reduction in pain scores was reported when the treatment group included more than one analgesic. Nausea and vomiting were the most common adverse events across all medication types (10.2%), with local anesthetic patients experiencing these side effects most frequently (38.0%). Perioperative acetaminophen was reported to have the fewest adverse drug reactions overall (6.1%), but did not reduce pain scores as much as other modalities, such as nonsteroidal anti‐inflammatory drugs (NSAIDs) or combination analgesics. Conclusions There is evidence that combination analgesics, such as acetaminophen plus codeine, provide superior pain relief to monotherapy analgesics in the perioperative pain management of otologic surgeries. NSAIDs, α‐agonists, and nerve blocks may also be viable single‐therapy options. Further prospective randomized controlled trials into perioperative analgesia for patients undergoing otologic surgery may be helpful in establishing a definitive consensus. Laryngoscope, 130:190–199, 2020

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Section: Resultsmentioning

confidence: 99%

Perioperative analgesia for patients undergoing otologic surgery: An evidence‐based review

et al. 2019

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“…The same two blinded anesthetists assessed injection pain using two pain scales, the Ontario Children's Hospital Pain Scale (mCHEOPS)[1112] and the Wong-Baker Face Scale[13] for each patient group (children rated their pain severity on a six-item ordinal faces scale from none to worst and a 100-mm VAS from mention the scores and its corresponding value, for example, 0 indicates no pain least to most). The pain assessment was made until the patient lost consciousness.…”

Section: Methodsmentioning

confidence: 99%

Injection pain of propofol in children: A comparison of two formulations without added lidocaine

Beyaz¹,

Eman²

2012

J Anaesthesiol Clin Pharmacol

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Background:Propofol emulsion in medium and long-chain triglycerides (MCT/LCT) has been reported to cause less injection pain than other propofol solutions in adult studies. The aim of this study was to compare the injection pain of two different propofol emulsions using two different pain scales on the pediatric population.Materials and Methods:100 children scheduled for general anesthesia were divided into two groups. Patients were randomly assigned to receive propofol LCT or propofol MCT/LCT. Assessment and evaluation of the Ontario Children's Hospital Pain Scale (mCHEOPS) and the Wong-Baker Faces Scale (WBFS) were performed at the start of the injection until the patients lose consciousness.Results:There were no significant differences between groups in terms of demographic data. According to the mCHEOPS scale, the pain incidence of propofol LCT was 5%, whereas for propofol MCT/LCT it was 15% (P < 0.05). According to the WBFS Pain Scale, the pain incidence of propofol LCT was 17%, whereas for propofol MCT/LCT it was 21% (P > 0.05).Conclusions:Propofol MCT/LCT does not decrease injection pain; contrary to the general assumption, it causes more pain than propofol LCT in children.

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“…21,22,[28][29][30] Expert insight and opinion. The author has regularly performed in-office tube insertion in awake children since 2010, 27,28 using a papoose board for protective stabilization, premedication with acetaminophen for postprocedure pain relief, 31 and topical phenol for local anesthesia (children age 2 years or older). At the time of this writing (March 2020), I have done this in over 500 children ranging from age 3 months to 9 years, typically using a beveled fluoroplastic tube or occasionally a t-tube (narrow canal) with over 98% success, mean procedure time of 4 to 5 minutes (both ears), high caregiver satisfaction, and no significant complications.…”

Section: What Is the Role Of New Automated Tympanostomy Tube Insertimentioning

confidence: 99%

Tympanostomy Tube Controversies and Issues: State-of-the-Art Review

Rosenfeld

2020

Ear Nose Throat J

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Objective: To review current pragmatic issues and controversies related to tympanostomy tubes in children, in the context of current best research evidence plus expert opinion to provide nuance, address uncertainties, and fill evidence gaps. Methods: Each issue or controversy is followed by the relevant current best evidence, expert insight and opinion, and recommendations for action. The role of expert opinion and experience in forming conclusions is inversely related to the quality, consistency, and adequacy of published evidence. Conclusions are combined with opportunities for shared decision-making with caregivers to recommend pragmatic actions for clinicians in everyday settings. Results: The issues and controversies discussed include (1) appropriate tube indications, (2) rationale for not recommending tubes for recurrent acute otitis media without persistent middle ear effusion, (3) role of tubes in at-risk children with otitis media with effusion, (4) role of new, automated tube insertion devices, (5) appropriateness and feasibility of in-office tube insertion in awake children, (6) managing methicillin-resistant Staphylococcus aureus acute tube otorrhea, and (7) managing recurrent or persistent tube otorrhea. Conclusions: Despite a substantial, and constantly growing, volume of high-level evidence on managing children with tympanostomy tubes, there will always be gaps, uncertainties, and controversies that benefit from clinician experience and expert opinion. In that regard, the issues discussed in this review article will hopefully aid clinicians in everyday, pragmatic management decisions.

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Topical lidocaine and oral acetaminophen provide similar analgesia for myringotomy and tube placement in children

Abstract: Topical lidocaine and oral acetaminophen in a dose of 30 mg x kg(-1) provide similar analgesia following BMT.

Cited by 19 publications

References 18 publications

Perioperative analgesia for patients undergoing otologic surgery: An evidence‐based review

Perioperative analgesia for patients undergoing otologic surgery: An evidence‐based review

Injection pain of propofol in children: A comparison of two formulations without added lidocaine

Tympanostomy Tube Controversies and Issues: State-of-the-Art Review

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