Analgesia
/ Anesthesia
Analgesia:
Primary
advantage = ease
of use.
1.
Acetaminophen
with codeine is
the most common analgesic combination employed
for tympanocentesis. Typical dose levels are 1 mg/kg codeine
with
10 mg/kg
acetaminophen.
2.
Midazolam, given either orally or intranasally, is
valued for its combined
analgesic, amnesic, and anxiolytic effects, but requires prior
training in conscious sedation techniques.
3. Ketamine at 5 to 10
mg/kg is
described as
an effective procedural analgesic, but can produce undesirable side
effects. Also requires prior training in conscious sedation
techniques.
4. Nitrous oxide is
occasionally
used, predominately for its amnesic and anxiolytic
effects.
5. Diazepam, meperidine,
and
morphine have all
at one time or another been mentioned as analgesic or sedative options,
but receive infrequent mention in recent literature. |
|
Anesthesia:
Primary
advantage =
faster effect.
1. Topical 8%
tetracaine otic solution provides anesthesia in 15
minutes. Use a cotton pledget to hold the solution
within the ear canal. Most anesthetic
solutions are bacteriostatic; practitioners who wish to
culture aspirate should wick excess anesthetic solution from
the ear canal prior to the procedure.
2. Topical 15%
lidocaine solution produces partial anesthesia after 30 minutes.
3. Iontophoresis
with
lidocaine
produces full anesthesia of the membrane in as little as 11
minutes,
but requires specialized equipment.
4. EMLA cream
is effective but difficult to apply and hold
in place,
and also difficult to cleanse from the ear
canal.
5. Phenol applied directly
to the
membrane is
both fast and effective, but is painful to the
patient during application.
|
 Dudley JP. Making
tympanocentesis easier. J Emerg
Med. 1990;8(6):765-767.
Hoberman A, Paradise JL. Acute
otitis media:
diagnosis and management in the year 2000. Pediatric Annals.
2000;29(10):609-620.
Hoberman A, Paradise JL, Wald
ER. Tympanocentesis
technique revisited. Pediatr Infect Dis J. 1997;16:S25-S26.
Kaplan SL, Feigin RD.
Simplified technique for
tympanocentesis. Pediatrics. 1978; 62(3):418-419
Luotonen J, Laitakari K,
Karjalainen H, Jokinen K.
EMLA in local
anaesthesia of the tympanic membrane. Acta Otolaryngol(Stockh). 1992;
Suppl.492:63-7.
Schmidt, SH. Anesthesia of the
tympanic membrane.
Arch Otolaryngol Head Neck Surg. 1995:121(3):353-4.
Schwartz RH. Myringotomy: A
neglected office
procedure. Am Fam Physician. 1979; 20(6):102-108.
Silverstein H, Kuhn J, Choo D,
Krespi YP, et al.
Laser-assisted tympanostomy. Laryngoscope. 1996;106(9 Pt 1):1067-1074.
van
Buchem FL, Dunk JH, van't Hof MA. Therapy of acute otitis media:
myringotomy, antibiotics, or neither? A double blind study in children.
Lancet.1981; 24;2(8252):883-887.
Walls
Precision Instruments offers this information as an informal
resource only.
No endorsement, expressed or implied, is made by Walls Precision
Instruments, or by any contributor to this forum, for any medication or
technique discussed in this forum. No liability will be assumed by
Walls Precision Instruments, or by any contributor to this forum, for
any consequences that may result from applying any medication or
technique discussed in this forum.
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