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Cited by 46Anesthesia and Pain ManagementPediatric Pain Management TechniquesAnesthesia and Sedative Agents

Analgesia after otoplasty: regional nerve blockade vs local anaesthetic infiltration of the ear.

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Cregg, Nuala, Conway, Frances, Casey, William·1996·Canadian Journal of Anaesthesia
DOI 10.1007/bf03011255
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Abstract

Purpose Children scheduled to undergo otoplasty experience severe pain postoperatively. Nausea and vomiting is also a problem. This study was designed to compare two analgesic techniques (i) regional nerve blockade (ii) local anaesthetic infiltration, with respect to quality and duration of analgesia, opioid requirements and the incidence of postoperative nausea and vomiting (PONV).Methods Forty three children, ASA I-II, aged 3-15 yr, were studied and followed for 24 hr postoperatively. Patients were randomised into two groups. Patients in Group A received local infiltration with lidocaine 1% with adrenaline 1:200,000 0.4 ml.kg-1 (n = 21). Patients in Group B (n = 22) received nerve blockade, bupivacaine 0.5%, 0.4 ml.kg-1. No other form of analgesia was used intraoperatively. Quality and duration of analgesia were assessed using pain and sedation scores recorded by a blinded observer at 0, 5, 10, 15, 30, 45 min with Recovery Room, and at 0, 30, 60, 90, 120, 180, 240, 360, 480 min on the ward. Pain score > 6 was treated with fentanyl 1 microgram.kg-1 iv (recovery) and morphine 0.2 mg.kg-1 im or mefenamic acid 8 mg.kg-1 po on the ward. Time to first supplemental analgesia was noted. Mean duration of analgesia was 8.6 (1.1-24) hr, Group A and 10.5 (1.3-24) hr, Group B (P > 0.7). 24% per cent of children (Group A) and 27% (Group B) required no supplemental analgesia (P > 0.6). The degree of pain control resulted in a low requirement for opioids, Group A: 24%, Group B: 14% (P:NS). The overall incidence of PONV was 43% (Group A) and 36% (Group B) (P:NS): PONV correlated with opioid use. There were no differences between the groups with regard to pain/sedation scores, quality/duration of analgesia, opioid requirements and incidence of PONV.Conclusion Both techniques provided excellent postoperative analgesia. Lidocaine 1% infiltration (adrenaline 1:200,000) has the added advantage of improving surgical field and haemostasis. Thus, we advocate use of the simpler technique.

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  • Two trials recorded statistically significant reductions in NRS scores within the first 12 hours, accompanied by lower rescue opioid use.

    “Two trials recorded statistically significant reductions in NRS scores within the first 12 hours, accompanied by lower rescue opioid use.1,7”

    From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [7]

    The Results report no significant difference in pain scores between the nerve-block and infiltration groups (recovery P > 0.35; ward P > 0.15). They also report no difference in postoperative analgesic requirements; the study used an Objective Pain Scale rather than an NRS. This trial therefore does not show the attributed significant reductions in pain scores or rescue opioid use. (LLM, conf=0.90)

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  • Taken together, the evidence supports regional nerve block as the preferred technique for sustained analgesia in otoplasty, with multiple studies demonstrating clinically-and in several trials statistically-meaningful benefits over local infiltration anesthesia.

    “Taken together, the evidence supports RNB as the preferred technique for sustained analgesia in otoplasty, with multiple studies demonstrating clinically—and in several trials statistically—meaningful benefits over LIA.1,7,24”

    From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [7]

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  • Local pinna infiltration remains simple and cost-effective.

    “Local pinna infiltration remains simple and cost-effective,7 yet where expertise and resources permit, the weight of current evidence supports an RNB + antiemetic bundle.”

    From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [7]

    The Discussion (page not provided) says local anaesthetic infiltration of the pinna is easy to perform, requires little technical skill, and is the simpler technique. The paper does not assess costs or state that infiltration is cost-effective. (LLM, conf=0.86)

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  • Agents such as bupivacaine or lidocaine with adrenaline provide extended analgesia throughout the perioperative period, reducing both pain intensity and postoperative nausea and vomiting.

    “Agents such as bupivacaine or lidocaine with adrenaline provide extended analgesia throughout the perioperative period, reducing both pain intensity and postoperative nausea and vomiting (PONV).7”

    From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [7]

    The Methods and Discussion (page not supplied) describe giving lidocaine with adrenaline or bupivacaine before incision and report effective postoperative analgesia lasting a mean of 8.6 and 10.5 hours, respectively. The paper does not establish that these agents reduced PONV: it found no significant difference between the two groups, and its suggested association between opioid use and PONV was too small for statistical analysis. It also did not compare pain intensity with a group receiving neither technique. (LLM, conf=0.88)

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  • Where duration was reported, a single regional nerve block injection provided 8 hours or more of analgesia.

    “Where duration was reported, a single RNB injection provided 8 hours or more of analgesia1,7; subsequent oral or parenteral drugs were administered only as needed.1,7,19”

    From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [7]

    The Results report a mean analgesia duration of 10.5 hours for the regional nerve block group, but individual durations ranged from 1.3 to 24 hours; the paper does not say every block provided at least 8 hours. The Discussion explicitly says two injections are required to block all three nerves, contrary to the claim of a single injection. (LLM, conf=0.90)

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Research works printed but not linked: 1

  1. taster M, Maxwell LG. Paediatric regional anaesthesia. Anesthesiology 1989; 70: 324-38.

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Authors
Cregg, N., Conway, F., & Casey, W.
Affiliations
Children's Health Ireland at Crumlin (IE)
Venue
Canadian Journal of Anaesthesia
Publisher
Springer Science and Business Media LLC
Published
1996-02
Volume
43
Issue
2
Pages
141-147
ISSN
  • 0832-610X (ISSN-L)
  • 1496-8975
DOI
10.1007/bf03011255
OpenAlex
W1968398322
Cited by
46
References
23
Citations by year
2026: 1 · 2025: 2 · 2023: 1 · 2022: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 1 · 2015: 1 · 2014: 1 · 2013: 2 · 2012: 1
FWCI
0.83
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Keywords
otoplasty, postoperative pain, nerve block, local infiltration anesthesia, lidocaine, bupivacaine, postoperative nausea and vomiting, opioid requirement, pediatric surgery, duration of analgesia, sedation score, mefenamic acid, fentanyl
MeSH terms
Adolescent, Analgesia, Anesthetics, Local, Child, Child, Preschool, Ear, External, Female, Humans, Lidocaine, Male, Nausea, Nerve Block, Postoperative Pain, Vomiting

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