International Journal of Pediatric Otorhinolaryngology ELSEVIER 35 (1996) 19-24 Topical lidocaine for postoperative analgesia following myringotomy and tube placement C. David Lawhorn*, Charles M. Bower, Raeford E. Brown, Jr., Michael L. Schmitz, Patti J. Kymer, Paula Volpe, Robert Shirey Division of‘ Pediatric Anesthesia, Arkansas Children’s Hospital, 800 Marshall Street, SturRis 319, Little Rock, AR 72202-3591, USA Received 4 May 1995; revision received 22 August 1995; accepted 23 August 1995 Abstract One of the most frequently performed surgical procedures in pediatrics is myringotomy and tube placement. Analgesia is often difficult to achieve and children may be uncontrol- lable, distressing both parents and nursing staff. We designed this investigation to determine if topical lidocaine instilled in the ear canal after myringotomy and tube placement could improve postoperative analgesia. This prospective, randomized, double-blind clinical trial compared topical 4% lidocaine combined with antibiotic drops to placebo and antibiotic drops placed in the external auditory canal following completion of myringotomy and tube placement. One hundred twenty-two ASA class I or II patients were enrolled and completed this investigation. Primary outcome measure was relief of pain based on pain scores and the need for acetaminophen. Patients who received 4% lidocaine with gentamicin had better pain scores (2.81; P = 0.002) than those receiving placebo (4.77). Twenty-seven patients (45%) in the control group received acetaminophen for treatment of postoperative pain compared to eight (13%) in the lidocaine group (P < 0.001). No reports or complaints of vertigo or tinnitus were noted in any patient. The application of 4% lidocaine in antibiotic drops significantly improves postoperative analgesia in patients undergoing myringotomy and tube insertion under general anesthesia. Utilizing this technique should help improve analgesia, specifically in the early postoperative period, and decreasethe presence of stress following surgery. Keywords: Myringotomy; Analgesia; Lidocaine; Acetaminophen; Ibuprofen * Corresponding author, Tel.: + I 501 3202936, Fax: + 1 501 3202939. Ol65-5876/96/$15.00 0 I996 Elsevier Science Ireland Ltd. All rights reserved SSDI 0165-5876(95)01275-G