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Usefulness of pre-emptive peribulbar block in pediatric vitreoretinal surgery: a prospective study
Rajeshwari Subramaniam1, Subramanyam Subbarayudu, Vimi Rewari
1Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India. rajeshwarisubramaniam@hotmail.com
Insights
Peribulbar block significantly reduces pain, vomiting, and the oculocardiac reflex in children undergoing vitreoretinal surgery compared to opioid analgesia. This regional anesthesia technique offers a safer and more effective option for pediatric patients.
Area of Science:
- Ophthalmology
- Anesthesiology
- Pediatric Surgery
Background:
- Vitreoretinal (VR) surgery in children is associated with significant postoperative pain and emesis.
- The role of regional anesthesia in managing these outcomes in pediatric VR surgery is understudied.
Purpose of the Study:
- To compare the efficacy and safety of peribulbar block versus conventional opioid analgesia in children undergoing VR surgery.
- To evaluate the impact of peribulbar block on intraoperative and postoperative parameters.
Main Methods:
- A prospective, randomized, single-blind study involving 85 children (ages 6-13) undergoing VR surgery.
- Children received either peribulbar block (n=42) or intravenous meperidine (n=43) post-general anesthesia induction.
- Key parameters included oculocardiac reflex, pain intensity, emesis, analgesic requirements, and parental comfort assessment.
Main Results:
- Peribulbar block significantly reduced the incidence of intraoperative oculocardiac reflex (P=.0001).
- More children in the peribulbar group were pain-free postoperatively (P=.0004) and required fewer opioid supplements (P=.008).
- A significant reduction in postoperative emesis was observed with peribulbar block (P=.001).
Conclusions:
- Peribulbar block is a safe and clinically superior alternative to intravenous opioids for pediatric VR surgery.
- Regional anesthesia effectively mitigates pain and emesis in this population.
Background And Objectives:
Vitreoretinal (VR) surgery with or without scleral buckling is associated with significant postoperative pain and emesis in adults, and recent studies have addressed the effect of retro or peribulbar block on these parameters. VR surgery in children has received little attention regarding the incidence of pain and emesis, and the role of regional anesthesia in modifying these parameters. In this study, we compared peribulbar block with conventional opioid analgesia in children undergoing VR surgery.
Methods:
In a prospective, randomized, single-blind study, 85 children (ages 6 to 13 years) were allocated to receive peribulbar block (n = 42) or intravenous meperidine 1 mg/kg (n = 43) after induction of general anesthesia. Parameters compared were: intraoperative incidence of oculocardiac reflex and requirement for additional analgesic; postoperative pain intensity; incidence of postoperative emesis; time to first analgesic, total number of postoperative analgesic supplements; and parental assessment of the child's postoperative comfort at 24 hours.
Results:
The incidence of intraoperative oculocardiac reflex was significantly less in the peribulbar group (P =.0001). Significantly more children receiving peribulbar block were pain free on awakening (P =.0004) and throughout the postoperative period. The number of children requiring opioid was significantly lower with peribulbar block (P =.008), and a significant number of children did not vomit throughout the postoperative period (P =.001).
Conclusions:
Peribulbar block appears to be a safe and clinically superior alternative to intravenous opioid for pediatric VR surgery.