The Use of Orbital Morphine for Postoperative Analgesia in Pterygium Surgery

Abstract

A prospective double-blind study compared the analgesic effectiveness of peribulbar lignocaine with peribulbar morphine and lignocaine for postoperative analgesia in pterygium surgery. Twenty patients were randomly divided to receive a peribulbar injection preoperatively of either 1% lignocaine 2 ml or 1% lignocaine 1.6 ml and 4 mg morphine. Effects on pain at injection and pain at 24 hours and 48 hours postoperatively were measured with a visual analog pain scale. Effects of the injections on sedation, pupil size and unwanted side-effects were also recorded. The groups were comparable for age, weight and surgical technique. There was a significantly lower pain score at 24 hours after operation in the morphine group (P=0.035). There were no significant differences in sedation or side-effects between the groups. The physiological effects of morphine on the eye are reviewed. The study suggests that orbital morphine may be an effective and safe form of analgesia for corneal surgery and further investigation is warranted.

Peripheral opioid analgesia: Clinical applications

“…There also have been attempts in local opioid analgesia for postoperative pain control after ophthalmosurgery. Pterygium patients receiving 4 mg of morphine plus 1.6 mL of lidocaine 1% (2-mL solution) injected peribulbar reported significantly lower pain scores 24 hours after pterygium surgery than the patients receiving injections of lidocaine 1% (2 mL) alone [49].…”

Cut and paste: a no suture, small incision approach to pterygium surgery

“…Wishaw and coworkers compared different analgesic methods. 16 We found no references regarding postoperative pain and surgery time when comparing different methods in pterygium surgery. In this study we present a new method, where autologous conjunctival graft was glued on the sclera and we compare the results with those obtained with sutured grafts.…”

Effect of Nepafenac Eye Drops on Pain Associated With Pterygium Surgery

“…There are many techniques and methods described for the management of postoperative pain. 5 Topical anesthetics may be administered to reduce postoperative pain. However, it was reported that they demonstrated serious 5 used morphine to prevent early postoperative pain after pterygium surgery.…”

“…5 Topical anesthetics may be administered to reduce postoperative pain. However, it was reported that they demonstrated serious 5 used morphine to prevent early postoperative pain after pterygium surgery. It also was of a limited use after pterygium surgery as orbital morphine was applied by peribulbar injection that can cause serious complications.…”

“…It is shown that approximately 60% of patients experience clinically significant pain after pterygium surgery in variable degrees. 5 Scraping of the corneal bed leaves numerous highly sensitive nerve endings exposed, leading to severe pain and neurogenic inflammation. 6 This response is mediated by prostaglandins synthesized from arachidonic acid by cyclooxygenase (COX).…”