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Comparison of retrobulbar analgesics for evisceration
Ari Giligson1, Peter J Dolman, Frank Buffam
1Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada.
Purpose:
To determine whether postoperative pain and nausea after evisceration surgery is better controlled with intraoperative retrobulbar ethanol or bupivacaine.
Methods:
Prospective, randomized, clinical trial. Eleven patients undergoing evisceration surgery by two surgeons over a 6-month period for blind, chronically painful eyes were randomly allocated in two groups. One group (5 patients) received prophylactic retrobulbar 95% ethanol injections; the control group (6 patients) received retrobulbar 0.75% bupivacaine with 1:100,000 epinephrine. Postoperative pain and nausea were recorded by the patients with the use of a 10-point analog scale. Patients also documented the quantity of analgesics required.
Results:
The mean and median postoperative pain and nausea scores were significantly lower for patients given intraoperative retrobulbar ethanol (paired t test, P<0.01). These patients also required significantly less analgesic medicine. Complications from the retrobulbar ethanol injections included forehead numbness and ptosis, both of which had resolved by the time of prosthesis fitting 6 weeks later.
Conclusions:
Surgeons should consider the use of intraoperative retrobulbar ethanol injections to help relieve postoperative pain and nausea.