Local Anesthesia (La) without Preoperative Sedation in Tympanoplasty

Background & Objectives: Local Anesthesia (LA) is getting popularity in comparison to general anesthesia (GA) in underdeveloped and developing countries in many otolaryngological operations. The rationale for LA is the lack of trained anesthesia staff, lack of adequate anesthesia machines and monitoring equipment. LA is safe; and ability to perform more cases in a shorter period of time. This study aimed to find out patients compliance in the operative procedures under LA without sedation.

Methods: 7905 patents underwent tympanoplsty under LA without sedation from 1999 to 2019 in the different hospital of Bangladesh. Preoperative thorough counselling with psychological motivation, advantages of LA, intraoperative surgeon patient conversation and watching surgical steps on monitor, tests of facial nerve function were explained to the patient. LA with different Adrenaline concentrations (1: 1000 to 1: 200,000) was used either by injection or topically. Patients’ satisfaction, vertigo, drowsiness, hangover, orientation and other parameters ware recorded.

Results: Amongst 7905 patients; male 56.2% and 43.8% was female. Maximum numbers (26.3) were found between 26 year to 35 year of age. Patients’ intraoperative compliance showed excellent without sedation. Operative time was short with a bloodless field. The overall safety was good and needed shortest hospital stay (Hour/day); and of course, very less expensive.

Conclusion: Patient’s safety is the primary objective considered in all patients. The advantages recorded as day/hour care hospital stay, patients comfort, less bleeding, ability to assess patient’s hearing during surgery and cost effectiveness.

Keywords: LA without sedation; Tympanoplsty; Safety; Cost effectiveness