Comparison of Superficial Cervical Plexus Block and Intravenous Morphine for Analgesia in Tympanomastoid Surgeries: A Randomized Double-Blind Control Trial

TL;DR

This study compares a neck nerve block to intravenous morphine for pain relief after ear surgeries, finding the nerve block provides better and longer-lasting pain control.

Contribution

Demonstrates that superficial cervical plexus block is non-inferior to intravenous morphine for postoperative analgesia in tympanomastoid surgeries.

Findings

SCPB group had significantly lower VAS scores at multiple time points post-surgery.

SCPB provided longer analgesia duration and reduced analgesic requirements compared to morphine.

Nausea, vomiting, and sedation were similar between the two groups.

Abstract

Background and aims

Superficial cervical plexus block (SCPB) has been indicated for many neck surgeries including thyroid surgery, carotid endarterectomy, clavicular surgeries, and cochlear implantation, but has not been used perioperatively to provide analgesia for otological surgeries. We hypothesized that the use of this block is not inferior to the use of intravenous morphine for postoperative analgesia. The primary objective was to compare the postoperative Visual Analogue Scale (VAS) scores in those receiving SCPB versus morphine. Secondary objectives included intraoperative hemodynamic stability, postoperative analgesic requirement, nausea and vomiting, and sedation.

Material and methods

A 100 subjects included in the study received either landmark-guided SCPB (n=50) or intravenous morphine (n=50) intraoperatively after induction. Intraoperative pulse rate and blood pressure were recorded. Postoperatively VAS scores, sedation, analgesic requirement and nausea and vomiting were noted for 24 hours.

Results

Ninety-six patients were analyzed in both groups, SCPB (n=47) and morphine (n=49). The demographic variables like age, weight, gender, and American Society of Anesthesiologists (ASA) score were comparable in both groups but the duration of surgery was significantly longer in the morphine group (p=0.016). The VAS scores were significantly reduced at one hour, three hours, six hours, 12 hours, and 24 hours in the SCPB group. The mean duration of analgesia was also significantly longer with a decreased analgesic requirement in the SCPB group (13.86±8.04 hour) compared to the morphine group (8.98±4.24 hour) with p-value=0.01. Postoperative nausea, vomiting, and sedation were equivocal in both groups.

Conclusion

Superficial cervical plexus block was not inferior to intravenous morphine when administered intraoperatively with respect to postoperative analgesia scores, analgesic requirement, and duration of analgesia.

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