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PEDIATRIC ANESTHESIA

Postoperative Analgesia in Children Undergoing Myringotomy and Placement Equalization Tubes in Ambulatory Surgery

Ana Lucia Pappas, MD^*, Elaine M. Fluder, RN MSN^*, Steve Creech, MS^*, Andrew Hotaling, MD, and Albert Park, MD

*Department of Anesthesiology, Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois

Address correspondence to Ana Lucia S. Pappas, MD, Department of Anesthesiology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153. Address e-mail to apappas{at}lumc.edu

We enrolled 120 children undergoing bilateral myringotomy and tube placement in this prospective, randomized, observer-blinded study. Patients were randomized into one of four groups: Group 1 (control) was plain acetaminophen 10 mg/kg orally, Group 2 was acetaminophen 10 mg/kg with 1 mg/kg of codeine orally, Group 3 was transnasal butorphanol 25 µg/kg given immediately after the induction of anesthesia, and Group 4 was ketorolac 1 mg/kg given IM immediately after the induction of anesthesia. All children received oral midazolam (0.6 mg/kg) before surgery. A nurse blinded to the analgesic technique used assessed the child’s behavior at the induction of anesthesia and in the postanesthesia care unit using a 4-point scale. Analgesic effectiveness was determined by assessing the child’s pain at 5-min intervals using a modified 10-point objective pain scale. In the postanesthesia care unit, rescue pain medication was administered for an objective pain scale 4 or a behavior score 3. Our data suggest that IM ketorolac is a promising analgesic to be used in this surgical population. Time to first rescue analgesic was longest in the ketorolac group, and there was no associated postoperative vomiting or nausea. IM ketorolac given during surgery was the best analgesic regimen for these procedures.

IMPLICATIONS: We compared four different analgesics in the management of pain after placement of pressure equalization tubes during myringotomy in children and demonstrated that ketorolac or butorphanol provided superior analgesia when compared with acetaminophen with codeine or plain acetaminophen. Children who received ketorolac versus butorphanol had less vomiting in the 24 h after surgery.

This article has been cited by other articles:

				S. M. Bhananker, L. Azavedo, J. MacCormick, and W. Splinter Topical lidocaine and oral acetaminophen provide similar analgesia for myringotomy and tube placement in children: [L'application topique de lidocaine et l'administration orale d'acetaminophene procurent une analgesie similaire pour la myringotomie et la pose d'un aerateur tympanique chez les enfants]. Can J Anesth, November 1, 2006; 53(11): 1111 - 1116. [Abstract] [Full Text] [PDF]

				American Academy of Pediatrics, Committee on Fetus and Newborn and Section on Surg, Canadian Paediatric Society, and Fetus and Newborn Committee Prevention and Management of Pain in the Neonate: An Update Pediatrics, November 1, 2006; 118(5): 2231 - 2241. [Abstract] [Full Text] [PDF]

				T. Hackmann Smaller Dose of 0.5 mg/kg IV Ketorolac Is Sufficient to Provide Pain Relief in Children Anesth. Analg., January 1, 2004; 98(1): 275 - 276. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999