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Strabismus surgery under augmented topical anesthesia.

Ossama M Hakim1, Yasser Gaber El-Hag, Mostafa A Haikal

  • 1Department of Pediatric Ophthalmology, Magraby Eye Center, Madina, Munwara, Saudi Arabia. oshakim@hotmail.com

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|June 16, 2005
PubMed
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Topical lidocaine jelly 2% with intravenous nalbuphine offers effective anesthesia for adjustable strabismus surgery. This combination ensures patient comfort and allows surgeons to achieve stable ocular alignment.

Area of Science:

  • Ophthalmology
  • Anesthesiology

Background:

  • Topical lidocaine 2% jelly has been utilized in ophthalmic surgeries like phacoemulsification and trabeculectomy.
  • Adjustable suture techniques in strabismus surgery allow for intraoperative fine-tuning of ocular alignment.

Purpose of the Study:

  • To evaluate the efficacy and stability of a one-stage adjustable suture technique.
  • To assess the combined use of topical lidocaine jelly 2% and intravenous nalbuphine for anesthesia in adjustable strabismus surgery.

Main Methods:

  • Forty adult patients (aged 16-46 years) received topical lidocaine jelly 2% and intravenous nalbuphine (10 mg) 10 minutes preoperatively.
  • Adjustments were made intraoperatively before conjunctival closure.
  • Stability was assessed by comparing post-adjustment deviation at 1 day, 1 week, and 3 weeks. Success was defined as alignment within 10 prism diopters. Analgesia and oculocardiac reflex were monitored.

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Main Results:

  • 95% of patients achieved successful alignment within 10 prism diopters on postoperative day 1, with sustained alignment at 3 weeks in 90%.
  • 35 patients reported no pain, 3 experienced discomfort, and 2 required additional nalbuphine.
  • No positive oculocardiac reflex was observed during intraoperative monitoring.

Conclusions:

  • The combination of topical lidocaine jelly 2% and intravenous nalbuphine is an effective anesthesia strategy for adjustable strabismus surgery.
  • This approach ensures patient comfort and enables surgeons to achieve precise ocular alignment intraoperatively.