Regional Nerve Blocks for Middle Ear Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With GRADE Assessment.

OBJECTIVE

Middle ear surgery is frequently associated with significant postoperative pain, nausea, and vomiting. Such issues have prompted clinicians to adopt regional nerve blocks, such as the superficial cervical plexus block (SCPB) and the great auricular nerve block (GANB). Our aim was to evaluate the efficacy of regional nerve blocks in adult patients undergoing different middle ear surgeries.

DATABASES REVIEWED: PubMed, the Cochrane Central Database of Controlled Trials and Systematic Reviews (CDSR), Scopus, Web of Science, and Google Scholar.

METHODS

Eligible randomized controlled trials (RCTs) used targeted nerve blocks (SCPB or GANB) against a sham block (saline) or standard care in adults undergoing middle ear surgery. Outcomes evaluated included pain scores, opioid consumption, rescue analgesics, postoperative nausea and vomiting (PONV), and adverse events (vertigo, dizziness, and tinnitus). Non-RCTs, pediatric/animal studies, and trials comparing 2 active blocks were excluded.

RESULTS

A total of 7 RCTs with 459 participants were included in this review. Regional nerve block significantly reduced postoperative pain at 1, 12, and 24 hours (MDs=-0.80, -0.78, and -0.41, respectively; all P <0.0001). In addition, there was a significant reduction in intraoperative remifentanil consumption (MD=-531.18 µg) and a lower incidence of PONV (RR=0.46). Reductions in rescue analgesic requirements and differences in the incidence of adverse events were not statistically significant.

CONCLUSIONS

SCPB and GANB represent a promising adjunct in perioperative care for middle ear surgery, offering better pain management and enhanced patient recovery. Further optimization of these techniques is key to ensuring all patients receive the best perioperative care.