Pediatric anesthesia & critical care
Middle Ear Condition at the Time of Pediatric Myringotomy Tube Placement: Pain Associations Following Intraoperative Fentanyl/Ketorolac and Seasonal Variation
Main finding · FLACC score ≥4Result — go to the resultOdds ratio 1.7 95% CI 1.2–2.3Authors' conclusion
Normal/unilateral infected ears at time of pediatric BMT are associated with higher incidence of moderate-to-severe postoperative pain following intraoperative fentanyl/ketorolac administration, but the predictive value of ear condition on pain is limited.
Study context
- Population
- Healthy children (9 months-7 years) undergoing bilateral myringotomy and tube placement (BMT) by a single surgeon, 2015–2020, with intraoperative IM fentanyl/ketorolac
- Participants
- 1,149 unique evaluable subjects
- Exposure
- Normal/unilateral infected vs bilateral infected middle ears at BMT
- Normal/unilateral infectedn = 692
- Bilateral infectedn = 457reference
- Outcome
- Maximum PACU Face, Legs, Activity, Cry, and Consolability (FLACC) score 4-10 (moderate-to-severe pain) vs 0-3
Methodological detailssingle-institution, single surgeon, generalized linear mixed-effect models, autoregressive integrated moving average (ARIMA) time-series analysis
- Single-institution
- Single surgeon
- Generalized linear mixed-effect models
- ARIMA time-series analysis
Main finding
FLACC score ≥4
Odds ratio
1.7
95% CI 1.2–2.3
P = 0.002
Events by group
Normal/unilateral infected vs Bilateral infected
OR 1.7 (95% CI 1.2–2.3); P = 0.002
As reported in the abstract
- Variability in pain outcome explained by the multivariable GLMM
- 4.7%
Observational data: associations, not effects.
Secondary outcomes
Bilateral infection prevalence
- Bilateral infection prevalence
- 39.8% (457/1149; 95% CI 37.0-42.6)
Moderate-to-severe pain behavior, overall
- Probability of moderate-to-severe pain
- 23.5% (270/1149; 95% CI 21.1-26.0)
Fentanyl dose response
- Oxycodone administration differed by fentanyl dose
- P ≤ 0.002
- Moderate-to-severe pain and emergence agitation more likely with reduced fentanyl dosing
Seasonal variation
- Bilateral infection prevalence seasonal, peaking in March and nadiring in July
- Pain outcomes did not vary by season
Original publication
Middle Ear Condition at the Time of Pediatric Myringotomy Tube Placement: Pain Associations Following Intraoperative Fentanyl/Ketorolac and Seasonal Variation. Anesth Analg. Published 2 November 2022. doi:10.
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