Intravenous access for ear tube placement surgery has no added benefit

Children who had intravenous (IV) access for ear tube placement surgery spent more time in the operating room and in the hospital and required more pain medication than children who underwent the same procedure without IV access, according to an article in the September issue of The Archives of Otolaryngology – Head & Neck Surgery, one of the JAMA/Archives journals.

According to the article, IV access (the placement of an IV line in a vein in the arm for the administration of medicines) allows for the administration of fluids (to prevent dehydration) and drugs or medications, but can result in discomfort, and parental dissatisfaction if many attempts are made to puncture the vein. Hospitals and medical institutions vary greatly as to requiring IV access for straightforward, short operations such as bilateral myringotomy with placement of pressure-equalizing tubes (BMT, placement of tubes through the eardrum to drain excess fluids).

Michael S. Haupert, D.O., of Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, and colleagues investigated whether IV access affects the incidence of postoperative vomiting (POV), postoperative pain, and length of hospital stay in children undergoing BMT placement.

The researchers enrolled 100 healthy children between the ages of two and 12 who were having BMT placement at a single hospital. The children were divided into two groups: one received IV access, and the other group did not. Anesthesia was administered through a face mask and all children received an injection of pain medicine into a muscle.

The researchers found that the two groups were similar in age, weight, and incidence of vomiting. Children with IV access spent more time than those without IV access in the operating room (21 minutes vs. 17 minutes), in phase 2 recovery (75 minutes vs. 51 minutes) and in the hospital (119 minutes vs. 88 minutes). Children with IV access also required more pain medication (31 percent vs. 2 percent) and parents of children in the IV access group were less satisfied with the procedure than parents whose children did not receive IV access (28 percent vs. 95 percent).

"Intravenous access in otherwise healthy children undergoing myringotomy provided no added benefit," the authors write. "Children without IV access had reduced pain requirement and spent less time in the operating room, in phase 2 recovery, and in the hospital. Parental satisfaction, a clinically relevant outcome, was significantly greater for parents of children without IV access."

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