A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra‐operative and postoperative complications during paediatric strabismus surgery

Abstract

We studied 45 ASA I/II children aged between 2 and 13 years scheduled for elective strabismus surgery, randomly allocated to receive either a peribulbar block or topical lidocaine 2% combined with general anaesthesia, or general anaesthesia alone. The incidence and severity of the occulocardiac reflex, the requirement for atropine, the occurrence of arrhythmias and incidence of postoperative nausea and vomiting following surgery at 1, 2 and 4 h were studied. We found the incidence and severity of occulocardiac reflex intra-operatively was significantly reduced in children who received a peribulbar block. The incidence of postoperative nausea and vomiting was significantly reduced in patients receiving either peribulbar block or topical local anaesthesia combined with general anaesthesia, compared to general anaesthesia alone (p = 0.008).

Peribulbar block or topical application of local anaesthesia combined for paediatric strabismus surgery

“…Gupta's current results [1] do not justify the routine use of peribulbar block in paediatric anaesthesia to prevent the trigemino-cardiac reflex. The potential usefulness of this technique is much smaller (especially in strabismus surgery), than the potential harmful side effects (e.g.…”

“…It is indeed heartening to know that our article [1] has stimulated the interest of Dr Schaller et al, who have carried out much research into the trigeminocardiac and oculocardiac reflexes. However, their concerns are unnecessary.…”

“…The MASTER [1] study remains, methodologically, the most robust study of epidural analgesia, albeit with all the limitations which have been mentioned. It gives an idea of the exceptionally poor level of evidence that has preceded it and that to a large extent has shaped modern epidural practice.…”

“…This needs to be re-examined. We read with great interest Gupta's recent study [1] where patients were randomly allocated to either peribulbar block or topical lidocaine combined with general anaesthesia, or general anaesthesia alone, investigating the oculo-cardiac reflex during strabismus surgery. The study is certainly a step in the right direction, as the authors demonstrated a significantly reduced incidence and severity of the oculo-cardiac reflex, part of the trigemino-cardiac Correspondence Anaesthesia, 2008, 63, pages 1139-1153 .…”

Asystole during Vitrectomy Secondary to Increasing Intraocular Infusion Pressure Transmitted via Sclerotomy Infusion Cannula

“…As atropine may precipitate more dangerous arrhythmias than the OCR itself, prophylaxis is typically reserved for pediatric patients. In pediatric strabismus surgery, bradycardia incidence decreased from 94% to 13% when regional anesthesia was added to general anesthesia alone [11]. The OCR is typically managed by releasing ocular pressure, increasing anesthetic depth, and rescue atropine.…”