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Adjunctive intra-operative local anaesthesia in paediatric strabismus surgery: a randomized controlled trial
S M Carden1, D J Colville, A J Davidson
1Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Adjunctive local anesthesia did not significantly reduce pain or hospital stay after pediatric strabismus surgery. Standard paracetamol was effective, potentially masking minor benefits of local anesthetics.
Area of Science:
- Ophthalmology
- Anesthesiology
- Pediatric Surgery
Background:
- Postoperative pain management is crucial in pediatric strabismus repair.
- Local anesthetics are sometimes used as an adjunct to systemic analgesia.
Purpose of the Study:
- To evaluate if topical amethica e or subconjunctival bupivacaine reduces postoperative pain, vomiting, or length of stay in children undergoing strabismus surgery.
- To test the hypothesis that adjunctive local anesthesia improves outcomes after strabismus repair.
Main Methods:
- Prospective, randomized, triple-armed clinical trial.
- Comparison of topical amethica e, subconjunctival bupivacaine, and topical normal saline (placebo).
- Treatments administered at the end of surgery before anesthetic emergence.
Main Results:
- No statistically significant differences in overall outcome measures between the three groups.
- Post hoc analysis showed a statistically significant difference in pain scores at 120 minutes between anesthetic groups and placebo.
- This difference was not clinically significant.
Conclusions:
- Topical amethica e and subconjunctival bupivacaine did not provide clinically significant benefits for postoperative pain, emesis, or length of stay.
- Moderate-dose rectal paracetamol appears effective for strabismus surgery analgesia.
- The effectiveness of paracetamol may have masked any minor adjunctive effects of local anesthetics.
Purpose:
The aim of the present study was to test the hypothesis that adjunctive local anaesthesia decreases postoperative pain, vomiting or length of stay in children having strabismus repair
Method:
A prospective, randomized, triple-armed clinical trial involving a treatment comparison between topical amethocaine, sub-conjunctival bupivacaine and, as a placebo, topical normal saline was performed. All treatments were given at the end of surgery before emergence from the anaesthetic.
Results:
Overall, there was no statistically significant difference between outcome measures in the three trial groups. Using post hoc analysis there was a statistically significant difference between the groups receiving amethocaine and bupivacaine compared with the saline group in terms of the pain score at 120 min postoperatively. This difference has little clinical significance.
Conclusions:
Neither topical amethocaine nor subconjunctival bupivacaine makes a clinically significant difference to postoperative pain, emesis or length of stay. Moderate dose paracetamol per rectum alone appears to be effective analgesia for strabismus surgery, although it probably masked any small adjunctive effect of the topical anaesthesia used in the present trial.