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Sub-Tenon's injection versus paracetamol in pediatric strabismus surgery
1Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Insights
Sub-Tenon block anesthesia effectively reduced postoperative agitation and vomiting in children after strabismus surgery compared to intravenous or rectal paracetamol. Oculocardiac reflex incidence remained similar across all analgesic methods.
Area of Science:
- Pediatric Anesthesiology
- Ophthalmologic Surgery
- Pain Management
Background:
- Emergence agitation, vomiting, and oculocardiac reflex (OCR) are common complications in pediatric strabismus surgery.
- Analgesia strategies are crucial for mitigating these adverse events.
- Comparing sub-Tenon's injection with intravenous (IV) and rectal paracetamol is essential for optimizing pediatric anesthesia protocols.
Purpose of the Study:
- To evaluate the efficacy of sub-Tenon's block versus IV and rectal paracetamol in reducing emergence agitation, vomiting, and OCR in children undergoing strabismus surgery.
- To compare the incidence of specific postoperative complications associated with different analgesic techniques.
Main Methods:
- A prospective, randomized, double-blind study included 90 children aged 4-8 years undergoing strabismus surgery.
- Three groups received different anesthesia/analgesia: Group A (sub-Tenon's bupivacaine), Group B (IV paracetamol), and Group C (rectal paracetamol suppository).
- Intraoperative OCR and postoperative agitation and vomiting were recorded and compared.
Main Results:
- No significant difference in oculocardiac reflex (OCR) incidence was observed between the groups.
- Postoperative agitation was highest in the rectal paracetamol group (Group C), followed by IV paracetamol (Group B), and lowest in the sub-Tenon's block group (Group A).
- Vomiting incidence was significantly lower in the sub-Tenon's block group (Group A) compared to IV paracetamol (Group B) and rectal paracetamol (Group C).
Conclusions:
- Sub-Tenon's block significantly decreased postoperative agitation and vomiting in pediatric strabismus surgery compared to IV and rectal paracetamol.
- Sub-Tenon's block offers a superior analgesic approach for managing specific postoperative complications in this patient population.
- No analgesic method demonstrated a significant difference in preventing oculocardiac reflex during strabismus surgery.
Background:
Emergence agitation, vomiting, and oculocardiac reflex (OCR) in children undergoing strabismus surgery under general anesthesia are common problems. The purpose of this study was to determine whether the effect of analgesia can reduce the incidence of these problems. We compared the effects of sub-Tenon's injection versus intravenous (IV) and rectal paracetamol in this surgery.
Methods:
In a prospective, randomized, double-blind study, ninety patients ranging in age from 4 to 8 years scheduled for extraocular muscle surgery for strabismus were included in this study. After induction of anesthesia, just before the surgery, children were divided into three groups (n = 30 for each group) Group A received sub-Tenon's anesthesia with 2.5% bupivacaine (0.08 ml/kg). Group B received IV paracetamol (20 mg/kg). Group C received paracetamol rectal suppository (40 mg/kg). The occurrence of oculocardiac reflex (OCR) intraoperatively was recorded. Then, in the Postanesthesia Care Unit, patients were assessed for their emergence behaviors. Vomiting was also noticed.
Results:
The OCR developed in few patients, and there was no significant difference between the groups. The highest number of patients with agitation was in Group C followed by Group B then Group A. Vomiting was significantly low in Group A followed by Group B then Group C.
Conclusion:
Sub-Tenon block in strabismus surgery in children decreased the incidence of postoperative agitation and vomiting compared with IV paracetamol then rectal paracetamol. There was no difference between sub-Tenon block and paracetamol in the incidence of oculocardiac reflex.
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