Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: a pilot study

Ophthalmologists are now encouraged to perform strabismus surgery as an outpatient procedure, but postoperative pain may be a barrier to discharge. Systemic analgesics have side effects or are contraindicated in some patients. We designed a trial to determine the efficacy of subtenons lidocaine injection at reducing postoperative pain and systemic analgesia requirements.

Children having unilateral primary horizontal muscle surgery were randomized to either receive an injection of 1 mL of 2% lidocaine into the inferonasal subtenons space or not. The child's parents, who were masked to the intervention, assessed pain over 4 hours postoperatively using an objective pain-scoring tool.

Seventeen children received injections and 14 did not. Five of the subtenons group required additional analgesia (29%) compared to 9 of the controls (64%, chi(2): P =.052). The pain scores at each time interval tended to be lower in the treatment group, compared to controls, statistically significantly so at the 2-hour observation (Mann-Whitney U test: P =.01).

These data provide some evidence of an association between the use of subtenons lidocaine injection and a reduction of pain experienced by children in the immediate postoperative period following primary strabismus surgery.