Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: A prospective randomized controlled trial

TY - JOUR

T1 - Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children

T2 - A prospective randomized controlled trial

AU - Sheard, Richard M

AU - Mehta, Jodhbir S

AU - Barry, John-S

AU - Bunce, Catey

AU - Adams, Gillian G W

PY - 2004/8

Y1 - 2004/8

N2 - BACKGROUND: We previously reported a pilot study of the use of subtenons lidocaine after primary, unilateral strabismus surgery in children. This study suggested an association between subtenons lidocaine administration at the conclusion of surgery and a reduction of pain in the immediate postoperative period. As a result of this pilot study we performed a full-scale prospective, randomized controlled trial to fully evaluate the efficacy of this intervention.METHODS: Children undergoing primary surgery or reoperations for strabismus were recruited. If randomized to the treatment group, 1 ml of 2% lidocaine was injected into the subtenons space of each operated eye, just prior to conjunctival closure. The child's parents, who were masked to the intervention, assessed pain over 4 h postoperatively using an objective pain-scoring tool. Pain scores were recorded on return to the ward (0 h, approximately 20 to 30 min after the completion of surgery) and at 1, 2, and 4 h later.RESULTS: One hundred eleven children were recruited, of whom 91 (82.0%) underwent unilateral and 20 (18.0%) underwent bilateral surgery. Ninety operations (81.1%) were primary procedures and 21 (18.9%) were reoperations. Fifty-four children (48.6%) were randomized to the treatment group and 57 (51.4%) were randomized to the control group. A subtenons lidocaine injection was associated with a significant reduction in pain at the 0 h observation (P = 0.0056), and the total pain score over the 4-h postoperative period was significantly lower in the treatment group compared to controls (P = 0.0381). There was no difference between the groups with respect to the need for additional systemic analgesia (P = 0.307).CONCLUSION: This study showed that an intraoperative injection of subtenons lidocaine is associated with a significant reduction in postoperative pain during the first postoperative hour for all types of childhood strabismus surgery. There was no difference between the groups in the need for systemic analgesia.

AB - BACKGROUND: We previously reported a pilot study of the use of subtenons lidocaine after primary, unilateral strabismus surgery in children. This study suggested an association between subtenons lidocaine administration at the conclusion of surgery and a reduction of pain in the immediate postoperative period. As a result of this pilot study we performed a full-scale prospective, randomized controlled trial to fully evaluate the efficacy of this intervention.METHODS: Children undergoing primary surgery or reoperations for strabismus were recruited. If randomized to the treatment group, 1 ml of 2% lidocaine was injected into the subtenons space of each operated eye, just prior to conjunctival closure. The child's parents, who were masked to the intervention, assessed pain over 4 h postoperatively using an objective pain-scoring tool. Pain scores were recorded on return to the ward (0 h, approximately 20 to 30 min after the completion of surgery) and at 1, 2, and 4 h later.RESULTS: One hundred eleven children were recruited, of whom 91 (82.0%) underwent unilateral and 20 (18.0%) underwent bilateral surgery. Ninety operations (81.1%) were primary procedures and 21 (18.9%) were reoperations. Fifty-four children (48.6%) were randomized to the treatment group and 57 (51.4%) were randomized to the control group. A subtenons lidocaine injection was associated with a significant reduction in pain at the 0 h observation (P = 0.0056), and the total pain score over the 4-h postoperative period was significantly lower in the treatment group compared to controls (P = 0.0381). There was no difference between the groups with respect to the need for additional systemic analgesia (P = 0.307).CONCLUSION: This study showed that an intraoperative injection of subtenons lidocaine is associated with a significant reduction in postoperative pain during the first postoperative hour for all types of childhood strabismus surgery. There was no difference between the groups in the need for systemic analgesia.

KW - Analgesia

KW - Anesthetics, Local

KW - Child

KW - Child, Preschool

KW - Connective Tissue

KW - Fascia

KW - Female

KW - Humans

KW - Infant

KW - Injections

KW - Lidocaine

KW - Male

KW - Ophthalmologic Surgical Procedures

KW - Pain Measurement

KW - Pain, Postoperative

KW - Prospective Studies

KW - Single-Blind Method

KW - Strabismus

KW - Clinical Trial

KW - Comparative Study

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1016/S1091853104000850

DO - 10.1016/S1091853104000850

M3 - Article

C2 - 15314590

SN - 1091-8531

VL - 8

SP - 314

EP - 317

JO - JOURNAL- AAPOS

JF - JOURNAL- AAPOS

IS - 4

ER -