The Efficacy of Greater Auricular Nerve (Gan) Block and Auriculotemporal Nerve (Atn) Block on Fentanyl Requirements During Surgery and Postoperative Pain Scale in Elective Mastoidectomy: A Randomized Controlled Trial

Background: Postoperative pain management remains challenging in surgical patients. High-dose fentanyl administration causes numerous side effects including respiratory depression, PONV, hypotension, hyperalgesia, and delayed emergence. Regional nerve blocks targeting the greater auricular nerve (GAN) and auriculotemporal nerve (ATN) may reduce fentanyl requirements and provide prolonged analgesia following ear surgeries, potentially minimizing opioid-related complications. Objectives: This prospective study included 46 ASA PS 1-2 patients undergoing elective mastoidectomy at Dr. Soetomo General Academic Hospital, Surabaya, between November 2024 and January 2025. Methods: Patients were randomized into two groups: standard general anesthesia (control) versus general anesthesia plus GAN and ATN blocks (intervention). Outcome measures included intraoperative fentanyl consumption and postoperative pain assessment using numeric rating scale (NRS) at 2, 6, and 12 hours. The data was examined by utilizing either an independent T-test or a Mann-Whitney test, depending on the situation. Result: The GAN and ATN blocks with 0.5% ropivacaine significantly reduced intraoperative fentanyl use (P<0.001) and decreased pain scores at 6 hours (P=0.02) and 12 hours (P=0.03) after surgery. Conclusion: GAN and ATN blocks with 0.5% ropivacaine in mastoidectomy procedures significantly reduce intraoperative and postoperative fentanyl requirements, accelerate extubation time, decrease PONV incidence, and effectively lower postoperative pain scores.