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

[L’application topique de lidocaïne et l’administration orale d’acétaminophène procurent une analgésie similaire pour la myringotomie et la pose d’un aérateur tympanique chez les enfants]

Sanjay M. Bhananker, MD FRCA^*, Lawrence Azavedo, MD FRCA^*, Johnna MacCormick, MD FRCSC and William Splinter, MD FRCPC^*

^* From the Department of Anesthesiology and
Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Address for correspondence: Dr. Sanjay M. Bhananker, Department of Anesthesiology, Box 359724, Harborview Medical Center, 325, 9^th Avenue, Seattle, WA 98104, USA. Phone: 206-731-3059; Fax: 206-731-8624; E-mail: sbhanank{at}u.washington.edu

Purpose: Preoperative oral acetaminophen (30 mg·kg^–1) was compared with topical 2% lidocaine ear drops for postoperative analgesia following bilateral myringotomy and tube placement (BMT) in children.

Methods: In a randomized, prospective, double-blind trial, we studied 124 patients, six months to eight years, ASA physical status I or II, undergoing elective BMT under general anesthesia. The patients in Group I received acetaminophen 30 mg·kg^–1 orally in a grape flavoured syrup 30 to 60 min before surgery and 0.9% saline drops (placebo) in each ear upon insertion of tympanostomy tube. Patients in Group II received a placebo (grape flavoured syrup) before surgery and 2% lidocaine, 0.5 mL in each ear when ear tubes were inserted. Postoperative pain assessments were recorded every five minutes in the postanesthesia care unit, and every 15 min in the day care surgical unit (DCSU) using the modified Children’s Hospital of Eastern Ontario pain scale (mCHEOPS), a ten-point scale. Pain at home was documented by parents using a 0 (no pain) to 10 (worst pain imaginable) scale.

Results: The median (range) mCHEOPS scores in the DCSU at 15 and 30 min were similar, i.e., 5 (4–9) in the acetaminophen group and 4 (4–8) in the lidocaine group. The proportion of patients receiving supplemental analgesics in the 24 hr following surgery was similar in both groups (45% and 42% respectively).

Conclusion: Topical lidocaine and oral acetaminophen in a dose of 30 mg·kg^–1 provide similar analgesia following BMT.

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