Amethocaine or ketorolac eyedrops provide inadequate analgesia in pediatric strabismus surgery

Kim, Jarmila; Azavedo, Lawrence; Bhananker, Sanjay M.; Bonn, G; Splinter, William M.

doi:10.1007/bf03019379

Cited by 22 publications

(20 citation statements)

References 18 publications

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“…The control of pain originating from the cornea and/or conjunctiva is a problem for the patients undergoing surgeries related to ocular surface, such as pterygium surgery, refractive surgery and even strabismus surgery [1, 3, 4]. For the prevention of postoperative pain after surgeries related to the ocular surface, NSAI drops, morphine and topical anesthetic drops have been applied [1, 3, 4].…”

Section: Discussionmentioning

confidence: 99%

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Pain Relief after Pterygium Surgery with Viscous Lidocaine

Öksüz

Tamer²

2006

Ophthalmologica

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Purpose:The aim of the current study is to investigate the efficacy of lidocaine 2% gel for the control of pain experienced after pterygium surgery. Methods: We conducted a prospective, randomized clinical trial on 45 eyes of 45 patients who underwent pterygium surgery. The patients were randomized into 2 groups. Group 1 was provided with topical 2% lidocaine gel and group 2 with artificial tear gel. The primary outcome of interest was the pain experienced at the 4th, 7th and 10th postoperative hours. Corneal reepithelization was evaluated by slitlamp biomicroscopy. Pain was determined using a 10-point linear visual analogue scale. No systemic analgesic or topical nonsteroidal anti-inflammatory drop was administered. Results: The groups had similar demographic data. The mean pain scores of the study and the control groups according to the visual analogue scale were: 4.13 ± 1.86 and 6.50 ± 1.47 (p = 0.001) at the 4th postoperative hour, 4.00 ± 1.16 and 4.00 ± 1.16 (p = 0.001) at the 7th , and 2.39 ± 0.89 and 3.63 ± 1.00 (p = 0.001) at the 10th postoperative hour, respectively. The mean area of the corneal epithelial defect in the lidocaine gel group was 4.78 ± 1.04 mm² and 4.68 ± 0.89 in the artificial tear gel group (p = 0.42). The mean corneal reepithelization time was 37.56 ± 10.42 h in the lidocaine gel group and 34.36 ± 10.00 h in the artificial tear gel group (p = 0.26). There were no side effects related to the drugs observed in either of the 2 treatment groups. Conclusion: We conclude that topical lidocaine gel is an effective and safe anesthetic agent for the control of pain experienced shortly after pterygium surgery.

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Section: Discussionmentioning

confidence: 99%

“…Nonsteroidal anti-inflammatory (NSAI) drugs, local anesthetic solutions and opioids have been used to reduce postoperative pain in ophthalmology [1, 3, 4]. Lidocaine gel is a viscous topical anesthetic agent which also has a lubricating effect.…”

Section: Introductionmentioning

confidence: 99%

Pain Relief after Pterygium Surgery with Viscous Lidocaine

Öksüz

Tamer²

2006

Ophthalmologica

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“…48,49 There is evidence of an association between topical diclofenac 50 and excellent analgesia with a low incidence of PONV; however, this benefit has not been demonstrated with ketorolac. 49 …”

Section: Opioidsmentioning

confidence: 99%

“…7,26 Analgésiques topiques L'efficacité de la tétracaïne topique a été démontrée dans deux études séparées; 46,47 toutefois, deux autres études n'ont pas montré d'avantage. 48,49 Certaines données soutiennent une association entre le diclofénac topique 50 et une excellente analgésie accompagnée d'une faible incidence de NVPO, mais cet avantage n'a pas été démontré avec le kétorolac. 49 …”

Section: Opioïdesunclassified

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Anesthetic management for pediatric strabismus surgery: Continuing Professional Development

Rodgers

Cox

2010

Can J Anesth/J Can Anesth

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Purpose Strabismus surgery is one of the most common pediatric ophthalmic procedures. The purpose of this continuing professional development module is to update physicians on the anesthetic considerations of pediatric patients undergoing strabismus surgery. Principal findings The preoperative assessment is important, as patients undergoing strabismus surgery may have an associated neuromuscular disorder, congenital syndrome, or cardiac disease. Malignant hyperthermia is no longer considered as being an issue associated with strabismus. The laryngeal mask airway is used frequently and has been shown as being associated with a low incidence of complications in strabismus surgery. The anesthesia technique can be adapted to decrease the incidence of the oculocardiac reflex and the oculorespiratory reflex, and the use of anticholinergic prophylaxis remains debatable. Since patients are at high risk for postoperative nausea and vomiting (PONV), combination anti-emetic therapy is recommended using dexamethasone and ondansetron. Metoclopramide was not found to provide additional benefit when combined with other anti-emetics. Droperidol is effective, but there remains a black box warning for dysrhythmias. Effective analgesics in this patient population include acetaminophen, nonsteroidal anti-inflammatory drugs, peribulbar blocks, and subtenon blocks. Topical tetracaine drops have demonstrated mixed results, and topical nonsteroidal anti-inflammatory drops were found not to be effective. The use of opioids should be minimized due to the increased incidence of PONV. Conclusions To provide optimal care for the pediatric patient undergoing strabismus surgery, it is important to understand the unique anesthetic considerations for strabismus surgery and to appreciate how each decision regarding the anesthetic technique can alter these considerations. Objectives of this continuing professional development (CPD) moduleUpon completion of this CPD module, the reader will be able to:1 Perform a thorough preoperative assessment with an emphasis on the co-existing diseases and syndromes with ocular manifestations; 2. Evaluate the possibility of an increased incidence of masseter muscle spasm or malignant hyperthermia in this patient group; 3. Detail an anesthetic plan for strabismus surgery, including airway management and choice of anesthetic agents; 4. Understand the mechanism of the oculocardiac and the oculorespiratory reflex and recognize the associated risk factors and treatment; 5. Determine the analgesia options for strabismus surgery; and 6. Plan evidence-based anti-emetic prophylaxis for strabismus surgery. Summary reviewStrabismus surgery is the most common pediatric ophthalmic procedure. 1,2 The purpose of this continuing professional development module is to review the unique anesthetic issues facing a patient presenting for strabismus surgery. It is important to be aware of specific issues, such as the association with specific syndromes and diseases, the occurrence of the oculocardiac reflex, and the increas...

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