Regional Anesthesia for Otologic Surgery: A Randomized Controlled Trial

Tuesday, October 1, 2024

8:06 AM – 8:12 AM EDT

Location: MBCC, 231

Disclosure(s):

Maxwell J. Bergman, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Vivian F. Kaul, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jameson K. Mattingly, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Opioids are the most commonly prescribed medication for postoperative pain management. However, opioids can be addictive and also exacerbate postoperative nausea and vomiting (PONV) in otology patients. Peripheral nerve blocks have been successfully applied to a variety of operative sites and have been an effective technique to decrease postoperative opioid requirements and associated PONV. Given the growing concern for opioids, the objective of this study is to determine if preoperative cervical plexus blockade results in decreased postoperative opioid usage and PONV.

Methods: This was a single-institution, randomized control trial of 104 adult patients undergoing outpatient otologic surgery. Patients were equally randomized into one of three study arms: control group (no regional anesthetic), superficial cervical plexus block, or superficial and intermediate cervical plexus block. Both blocks utilized ropivacaine 0.75%, with the superficial cervical block localized at the posterior border of the SCM muscle and the intermediate block utilizing an ultrasound-guided injection at the cervical rootlets between the anterior and middle scalene muscles. Opioid and anti-emetic medications given intra- and postoperatively were compared between the three groups.

Results: There was no statistical difference found in opioid usage when comparing the three protocols individually. There was also no significant difference in opioid or anti-emetic usage between the two nerve block protocols. When combining blocking protocols (protocols 2 and 3), there was a near significant decrease in post-operative opioid usage (p = 0.051). The combined blocking protocols also had significantly decreased intra-operative anti-emetic use when compared with the control group (p = 0.025).

Conclusions: Our study demonstrates that peripheral nerve blocks show promise in reducing PONV and opioid use in our surgical patients. Future studies into subjective patient pain scores and stratification base on surgery type would provide further insight into the full benefits of nerve blocks in otologic surgery.

Presenting Author(s)

MB

Maxwell J. Bergman, MD

Fellow
University of Iowa
Coralville, IA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
MB

Maxwell J. Bergman, MD

Fellow
University of Iowa
Coralville, IA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

RA

Riddhima Agarwal, MD

Department of Surgery - UW-Madison, United States

Disclosure information not submitted.
RA

Riddhima Agarwal, MD

Department of Surgery - UW-Madison, United States

Disclosure information not submitted.
Vivian F. Kaul, MD

Assistant Professor
University of Texas Health Science Center at Houston
Houston, Texas, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Vivian F. Kaul, MD

Assistant Professor
University of Texas Health Science Center at Houston
Houston, Texas, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
JM

Jameson K. Mattingly, MD

Physician
Ear Nose & Throat Consultants of East Tennessee
Knoxville, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
JM

Jameson K. Mattingly, MD

Physician
Ear Nose & Throat Consultants of East Tennessee
Knoxville, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Varun V. Varadarajan, MD

Neurotologist
Sacramento Ear, Nose, and Throat
Aurora, CO, United States

Disclosure information not submitted.
Varun V. Varadarajan, MD

Neurotologist
Sacramento Ear, Nose, and Throat
Aurora, CO, United States

Disclosure information not submitted.

Senior Author(s)

RB

Richard Bryant, MD

The Ohio State University, United States

Disclosure information not submitted.
RB

Richard Bryant, MD

The Ohio State University, United States

Disclosure information not submitted.
Edward E. Dodson, MD

Attending Physician
Ohio State University
Columbus, OH, United States

Disclosure information not submitted.
Edward E. Dodson, MD

Attending Physician
Ohio State University
Columbus, OH, United States

Disclosure information not submitted.