# Minimally Invasive Interventions in Obstructive and Inflammatory Salivary Gland Diseases: Local Anesthesia Based Pain Management, Stratification of Invasiveness, and Patients’ Perceptions

## TL;DR

This study shows that minimally invasive salivary gland treatments under local anesthesia can be effective, efficient, and well-tolerated by patients.

## Contribution

A stratified protocol for local anesthesia and pain management in salivary gland diseases based on invasiveness levels is proposed and validated.

## Key findings

- The protocol was successfully applied to all 377 patients with 470 interventions.
- 88.1–97% of patients rated the procedures as 'well acceptable' or better.
- 96.4% of patients would undergo the same treatment again under similar conditions.

## Abstract

Objectives: Since the peri- and intraoperative management of patients with inflammatory and obstructive sialadenitis (IOS) differs significantly between treating centers worldwide, we investigated whether these patients can be treated successfully, resource-savingly and with high patient satisfaction using minimally invasive procedures under local anesthesia (LA). Methods: We developed a comprehensive, stratified routine anesthesia and pain management protocol based on our proposed classification of invasiveness (grade 1–4), for almost all available IOS treatment procedures. We included 377 patients with 470 LA-conducted interventions in our study and evaluated their perceptions during and after the treatment. Results: The protocol was applied to all 377 study participants for all 470 interventions. The mean grade of invasiveness was 2.49 ± 1.31, with a mean procedure duration of 30 ± 20 min. We found a significant positive association between invasiveness levels and procedure duration (p = 0.001) or pain directly after surgery (p = 0.004). Patients rated the procedures as ”well acceptable” or better in a large majority (88.1–97%) regarding the administration and potency of LA, procedure duration, and pain during and directly after surgery. In total, 96.4% of patients would have the treatment repeated under the same conditions. Conclusions: The proposed anesthesia and pain management regimen, respecting invasiveness levels, enables IOS patients to undergo treatment under LA with high success rates, serving as a potential guide for performing physicians.