The Impact of Ultrasound-guided Greater Auricular Nerve Block on Emergence Agitation in Children Undergoing Cochlear Implantation

Objective This prospective, randomized, controlled trial aims to determine whether ultrasound-guided greater auricular nerve block (GANB) can reduce emergence agitation in children undergoing cochlear implantation. Methods In this prospective, randomized, controlled trial, we enrolled 100 children (aged 8 months to 6 years) scheduled for cochlear implantation. They were randomly assigned to one of two groups: the GANB group and the control group. The GANB group received an ultrasound-guided GANB with 2 mL of 0.25% ropivacaine, whereas the control group received no injection. Postoperatively, the incidence of emergence agitation was assessed using the Paediatric Anaesthesia Emergence Delirium (PAED) scale, and pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Children with a PAED score ≥ 13 or a FLACC score ≥ 4 were treated with 0.1 µg/kg of sufentanil. Results A total of 90 children (n = 45 per group) completed the study. The end-tidal concentration of sevoflurane was lower in the GANB group than in the control group. The incidence of emergence agitation was 17.7% in the GANB group, compared to 42.2% in the control group (P = 0.011). The PAED scale scores were lower in the GANB group (6 [4–8.5]) than in the control group (9 [6–12]). The duration of emergence agitation was shorter in the GANB group, and the FLACC scores in the post-anaesthesia care unit were lower in the GANB group (1 [1–2]) compared to the control group (3 [1–3]). Conclusions Ultrasound-guided GANB performed before surgery significantly reduced the incidence and duration of emergence agitation in children undergoing cochlear implantation. It also provided satisfactory postoperative analgesia without delaying extubation.