Comparing the effect of local injection of combined morphine, triamcinolone and lidocaine and lidocaine injection on pain intensity after mastoidectomy-tympanoplasty; a triple-blind clinical trial

Abstract

Introduction: Postoperative pain control is one of the patient’s rights and the challenges of surgeons and anesthesiologists since about 20% of patients experience severe pain in the first 24 hours after surgery. Mastoidectomy and tympanoplasty are common surgeries in the head and neck area, in which profound and long-term analgesia is essential. Objectives: The present study investigated the effect of the combination of topical morphine, triamcinolone, and lidocaine compared to the control group. Patients and Methods: In the current clinical trial, 68 patients’ candidates for mastoidectomy-tympanoplasty surgery were included and randomly divided into intervention and control groups. The variables of demographic, pain, hemodynamics, extubation time, and received opioids were measured. Results: The results of the current study indicated a significant reduction in the patient’s pain scores in both groups (P=0.001), while the patients of group 1 had significantly lower pain scores than group 2 after 8, 12, and 24 hours in the ward (P<0.05). Moreover, a significant reduction was observed in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in all patients during surgery (P<0.001). However, in patients who received morphine, triamcinolone, and lidocaine (group 1), SBP and MAP were significantly lower than group 2 after 40, 80, 100, 120, 140, and 160 minutes during surgery (P<0.05). Conclusion: The present study indicated that the combination of morphine, triamcinolone, and lidocaine compared to the control group could lead to better pain control, further reduction of SBP and MAP, reduction of post-operative opioid use, and delay during the first opioid administration. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20200825048515N39; https://irct.ir/trial/57931, ethical code; IR.MUI.MED.REC.1400.064).