- Original Article
- Open access
- Published:
Use of local anesthesia in ear surgery: technique, modifications, advantages, and limitations over 30 years’ experience
The Egyptian Journal of Otolaryngology volume 32, pages 161–169 (2016)
En
Abstract
Background
Local anesthesia (LA) is safe and well established for a variety of ear operations. It has many advantages compared with general anesthesia (GA).
Objective
This article is intended to be a comprehensive reference for those who use this art, in which we have more than 30 years of experience. We also aimed to find out the effect of LA on blood pressure (BP) and heart rate (HR), operative time, time of anesthesia with different adrenaline concentrations, and patient satisfaction with LA.
Patients and methods
This was a retrospective study of our experience in the technique of LA in more than 2600 patients spanning more than 30 years, along with modifications introduced. Additional prospective trials were also conducted. BP and HR were monitored during LA injection in 200 patients. The calculated operative time was compared between two groups of 21 patients each: the first group was operated upon under LA and the other under GA. Anesthesia time was calculated for LA with different adrenaline concentrations (1: 20 000–1: 200 000 and 0% or no adrenaline) by means of injections over both the mastoid and the forearm on five volunteers. Patient satisfaction was measured using postoperative questionnaire in 200 patients.
Results
Patients showed initial increase in BP due to apprehension, which was abolished with diazepam; a second increase in BP and HR occurred after LA injection by 3–10 min. LA statistically significantly shortened the operative time compared with GA. Time of anesthesia was longer using anesthetic solution with higher adrenaline concentration and was longer on the mastoid as compared with the forearm. Finally, 92% of the patients showed satisfaction from the procedure.
Conclusion
LA is a safe and effective way of anesthesia in ear surgery, allowing intraoperative testing of hearing, facial nerve action, and eustachian tube patency. With high adrenaline concentration, it allows excellent hemostasis, shortens the operative time, and increases the time of anesthesia, allowing probable prolonged postoperative analgesia and is well tolerated by the patients.
References
Caner G, Olgun L, Gültekin G, Aydar L. Local anesthesia for middle ear surgery. Otolaryngol Head Neck Surg 2005;133(2):295–297.
Yung MW. Local anaesthesia in middle ear surgery: survey of patients and surgeons. Clin Otolaryngol Allied Sci 1996;21(5):404–408.
El-Begermy M, Abd El-Kader A. High adrenaline concentration with local anesthesia in ear surgery. Proceedings of symposium on recent trends in anesthesia and intensive care; Industrial Jubail City, KSA: Al-Fanateer Hospital; 1990. pp. 1–13.
Andreassen UK, Larsen CB. Anesthesia in ear surgery. A resource economical analysis and patient assessment of general anesthesia versus local anesthesia in ear surgery. Ugeskr Laeger 1990;152(22):1595–1597.
Lancer JM, Fisch U. Local anaesthesia for middle ear surgery. Clin Otolaryngol Allied Sci 1988;13(5):367–374.
Abdul-Latif RM. Stapedectomy data base study [MS degree in OLR]. Cairo, Egypt: Faculty of Medicine, Ain Shams University; 2012.
El-Begermy MA, Rabie AN. A novel surgical technique for management of tinnitus due to high dehiscent jugular bulb. Otolaryngol Head Neck Surg 2010;142(4):576–581.
Sarmento KM Jr, Tomita S. Retroauricular tympanoplasty and tympanomastoidectomy under local anesthesia and sedation. Acta Otolaryngol 2009;129(7):726–728.
Habibollahi P, Mahboobi N, Esmaeili S, Safari S, Dabbagh A, Alavian SM. Halothane-induced hepatitis: a forgotten issue in developing countries. Hepat Mon 2011;11(1):3–6.
Pöntinen PJ. Cardiovascular effects of local adrenaline infiltration during halothane anaesthesia and adrenergic beta-receptor blockade in man. Acta Anaesthesiol Scand 1978;22(2):130–144.
Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesth Prog 2006;53(3):98–108. quiz 109–110.
Jackson D, Chen AH, Bennett CR. Identifying true lidocaine allergy. J Am Dent Assoc 1994;125(10):1362–1366.
Neal JM, Bernards CM, Butterworth JF4th, di Gregorio G, Drasner K, Hejtmanek MR et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med 2010;35(2):152–161.
Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105(1):217–218.
Stiell IG, Hebert PC, Weitzman BN, Wells GA, Raman S, Stark RM et al. High-dose epinephrine in adult cardiac arrest. N Engl J Med 1992; 327: 1045–1050.
McCann G. Pharmacological treatment of significant cardiac arrhythmias. Br J Sports Med 2000;34(5):401–402.
Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 1996;276(16):1328–1331.
Varon J, Marik PE. Clinical review: the management of hypertensive crises. Crit Care 2003; 7: 374–384.
Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999;318(7200):1730–1737.
Tyrer P. Anxiolytics not acting at the benzodiazepine receptor: beta blockers. Prog Neuropsychopharmacol Biol Psychiatry 1992; 16: 17–26.
Angeli P, Chiesa M, Caregaro L, Merkel C, Sacerdoti D, Rondana M, Gatta A. Comparison of sublingual captopril and nifedipine in immediate treatment of hypertensive emergencies. A randomized, single-blind clinical trial. Arch Intern Med 1991;151(4):678–682.
Kazerani H, Hajimoradi B, Amini A, Naseri MH, Moharamzad Y. Clinical efficacy of sublingual captopril in the treatment of hypertensive urgency. Singapore Med J 2009;50(4):400–402.
Abdellatif AA, Elkabarity RH, Hamdy TA. Dexmedetomedine vs midazolam sedation in middle ear surgery under local anesthesia: effect on surgical field and patient satisfaction. Egypt J Anaesth 2012; 28: 117–123.
Ghanem AM. Cartilage tympanoplasty (type 1) by local anaesthesia ‘Costs and Results’ Thesis Submitted for partial Fulfillment of MS degree in ORL. Cairo, Egypt: Al Azhar University; 2003.
Author information
Authors and Affiliations
Corresponding author
Additional information
Conflicts of interest
There are no conflicts of interest.
Rights and permissions
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
El-Begermy, M.A., El-Begermy, M.M., Rabie, A.N. et al. Use of local anesthesia in ear surgery: technique, modifications, advantages, and limitations over 30 years’ experience. Egypt J Otolaryngol 32, 161–169 (2016). https://doi.org/10.4103/1012-5574.186541
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1012-5574.186541