Regional Anesthesia for Otologic Surgery: A Randomized Controlled Trial
Opioids, which can be highly addictive and exacerbate postoperative nausea and vomiting in otology patients, are the most-commonly prescribed medication for pain management following surgery. Research led by Vivian Kaul, MD, chief of otology and an assistant professor in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston, examined the effect of preoperative cervical plexus blocks to decrease both opioid usage and nausea and vomiting in a study of 104 adult patients who underwent outpatient otologic surgery at a single institution. The results were presented at the 2024 meeting of the American Academy of Otolaryngology-Head and Neck Surgery.
“We randomized our patients equally to one of three study arms – a control group with no regional anesthetic, a group treated with a superficial cervical plexus block, and a group treated with superficial and intermediate cervical plexus blocks,” Dr. Kaul says. “For the third group, we used ropivacaine at the same concentration in both blocks, with the superficial block localized at the posterior border of the sternocleidomastoid muscle and the intermediate block performed by ultrasound-guided injection at the cervical rootlets between the anterior and middle scalene muscles.”
The researchers found no statistical difference in morphine equivalency when they compared the three protocols individually. When they combined the two blocking protocols, they found a near-significant decrease in postoperative opioid usage. The combined blocking protocols also significantly decreased intraoperative anti-emetic use when compared with the control group.
“We believe that nerve blocks show promise in reducing postoperative nausea and vomiting and opioid use,” Dr. Kaul says. “Nerve blocks have limited morbidity. They are quickly performed, and anecdotally, patients say they are satisfied. For more insight into the full benefits of nerve blocks in otologic surgery, we need future studies into subjective patient pain scores and stratification based on the type of surgery.”
“We believe that nerve blocks show promise in reducing postoperative nausea and vomiting and opioid use,” Dr. Kaul says. “They have limited morbidity and are quickly performed. Anecdotally, patients say they are satisfied. For more insight into the full benefits of nerve blocks in otologic surgery, we need future studies into subjective patient pain scores and stratification based on the type of surgery.”
The trial was conducted at the Ohio State University during Dr. Kaul’s tenure there as a faculty member prior to joining UTHealth Houston.