Background: Proper selection of anesthetic technique is important in middle ear microsurgery. Controlled hypotension in ear surgery decreases blood loss with improved quality of the surgical field, however, it is associated with resistance to vasodilators and delayed recovery from anesthesia. The use of local anesthetic technique alone in middle ear surgery decreases bleeding and reduces postoperative pain, however, pain on injection, noise, and head-neck position had been reported with the increased risk of patient injuries. This study aimed to compare the effects of local ear block combined with general anesthesia versus general anesthesia alone, regarding intraoperative hemodynamics, anesthetic consumption, recovery characteristics, postoperative pain, adverse effects and postoperative complications.
Eighty adult patients undergoing middle ear surgery (tympanoplasty with or without mastoidectomy) were enrolled in the study. Patients were randomized into two equal groups (40 patients each). A standardized general anesthetic technique was used in both groups. Group I, received general anesthesia combined with ear block using 10 ml of 0.25% bupivacaine and (Group II), received general anesthesia alone combined with ear block using 10 ml saline. Propofol 2-3 mg /Kg was administered to induce anesthesia, which was maintained using isoflurane. Hemodynamic variables, surgical conditions including the quality of the operative field, intraoperative fentanyl, vasodilators (propranolol and nitroglycerine), isoflurane consumption, recovery time, postoperative pain, total analgesics consumption and postoperative complications were recorded
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
QUADRUPLE
Enrollment
80
ear block by 0.25% bupivacaine
ear block by Normal Saline Flush, 0.9% Injectable Solution
general anesthetic by midazolam 0.02 mg kg-1 , propofol 2-3 mg kg-1 and lidocaine 0.5 mg kg-1 , fentanyl 2 μg kg-1 , atracurium 0.5 mg kg-1 , isoflurane in 50% oxygen/air.
hypotensives for deliberate hypotension by nitroglycerine 0.5-10 μg /kg/min and increments of 0.2 mg propranolol
Faculty of Medicine
Cairo, Shebin El-kom, Egypt
mean arterial blood pressure
mean arterial blood pressure in mmHg
Time frame: at arrival to the operating room,1 minute after induction of anesthesia,1 minute after surgical incision,then every 15 minutes till the time of complete surgical wound closure. - postoperative every one hour for 4 hours then every 4 hours for 24 hours
heart rate
heart rate in beats /minute
Time frame: at arrival to the operating room,1 minute after induction of anesthesia,1 minute after surgical incision,then every 15 minutes till the time of complete surgical wound closure. - postoperative every one hour for 4 hours then every 4 hours for 24 hours
quality of the operative field
four-point scale from 0=no bleeding (excellent surgical conditions), 1=minimum bleeding (sporadic suction), 2= diffuse bleeding (repeated suction), and 3=abundant (troublesome) bleeding
Time frame: every 15 minutes from start of the surgical incision till the time of complete surgical wound closure.
recovery time
the time from cessation of all anesthetics until complete recovery using the Aldrete's score
Time frame: time from stopping of all anesthetics till the patient had Aldrete's score of 9.
postoperative pain
measured by visual analogue scale (from 0 "no pain" to10 "worst imaginable pain")
Time frame: postoperative: at the time that the patient had Aldrete's score of 9. ,then every 4 hours for 24 hours.
total analgesic consumption
ketorolac consumption in mg
Time frame: in the first 24 hours postoperative
nitroglycerine consumption
total nitroglycerine consumption in ug
Time frame: during the operation time
propranolol consumption
total propranolol consumption in mg
Time frame: during the operation time
nausea
the number of patients who developed nausea
Time frame: in the first 24 hours postoperative
vomiting
the number of patients who developed vomiting
Time frame: in the first 24 hours postoperative
headache
the number of patients who developed headache
Time frame: in the first 24 hours postoperative
facial palsy
the number of patients who developed facial palsy
Time frame: in the first 24 hours postoperative
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