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

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.