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Author for correspondence: Dr Christopher Badenhorst, 88 South Karori Road, Karori, Wellington 6012, New Zealand E-mail: [email protected]
Dr C Badenhorst takes responsibility for the integrity of the content of the paper
Presented at the 67th Annual General and Scientific Meeting of New Zealand Otolaryngology and Head and Neck Surgery, 13–16 October 2014, Rotorua, New Zealand.
Introduction
Bilateral myringotomy with placement of ventilating tubes is a very common procedure worldwide. In New Zealand, the rates for bilateral myringotomy and tube placement are comparable to those in the UK and USA, at approximately 3–7 per 1000 children, making it one of the most common surgical procedures across all ages. Previous studies suggest that up to 76 per cent of children will require analgesia following bilateral myringotomy and tube placement.1 Consequently, a number of analgesic agents have been studied for bilateral myringotomy and tube placement surgery. These include: oral paracetamol (acetaminophen), oral and intramuscular non-steroidal anti-inflammatory drugs, oral codeine, topical lidocaine, topical phenol, transnasal butorphanol, and intranasal fentanyl.1–11
Assessing pain in children is often complicated by the phenomenon of emergence agitation following induction with inhaled anaesthetic agents, especially in pre-verbal and pre-school aged children.12,13 Recent studies have provided a better understanding of emergence agitation, as well as suggesting proven techniques to reduce its occurrence and hence its confusion with pain.14 Surprisingly, none of these preventative techniques have been applied in previous studies addressing pain after bilateral myringotomy and tube placement surgery. This begs the question: could some observations of this pain in patients be attributable to emergence agitation? Furthermore, additional confounding factors, such as the use of an intravenous (IV) cannula, airway adjuncts, and inadvertent canal wall or middle-ear trauma during bilateral myringotomy and tube placement, may also influence post-operative pain and they too have yet to be addressed.
Some studies have assumed that bilateral myringotomy and tube placement is painful, and have focused on which analgesic agent is most effective, without the use of a placebo. Pain is subjective, and instead of asking the question ‘is bilateral myringotomy and tube placement painful?’, we ask ‘is routine pre-emptive analgesia necessary in children undergoing bilateral myringotomy and tube placement?’.
A double-blinded, randomised, placebo-controlled study was conducted to compare the benefit of...