Does Topical Proparacaine Improve Postoperative Comfort After Strabismus Surgery?

Robert W Arnold, Aleah N Bond, Robert W Arnold, Aleah N Bond

Abstract

Background: Strabismus surgery is often performed on children and adults as a quick-turnover, outpatient procedure under general anesthesia. Ideal methods to reduce post-operative pain and nausea are not yet perfected. We postulated that a simple topical anesthetic drop after surgery might help.

Methods: In a prospective study of oculocardiac reflex (OCR) and strabismus surgery, a cohort of ongoing patients either received proparacaine immediately post-op, or none. Co-variables were Intraoperative opioid and OCR, patient age, type of surgery. Several post-operative recovery outcome variables were prospectively monitored.

Results: Sixty strabismus surgery patients (age 15±22 years) received proparacaine 1% while another 80 (16.5±22 years) received none; both received topical antibiotic-steroid ointment. Pain and nausea (Likert scale) were not impacted by covariables complexity of case, age less than 3.5, OCR >33% drop, intraoperative opioid or neuro-status. Immediate post-op heart rate was lower if OCR >33% and if opioids used. Time until discharge was shorter in younger patients. Proparacaine did not impact outcome variables, except in patients younger than 3.5 years when post-op pain was worse.

Conclusion: Post-op topical anesthetic either produced no difference, or worsened post-op pain and recovery. This prospective study does not support the use of topical anesthetic drop to reduce post-strabismus pain and nausea.

Clinical trials registration: NCT03672435, Strabismus Recovery With Proparacaine and Oculocardiac Reflex (OCRprop).

Keywords: anesthesia recovery; nausea and vomiting; oculocardiac reflex; topical anesthetic.

Conflict of interest statement

Dr. Arnold is a board member of Glacier Medical Software that markets ROP-Check NICU software and of PDI Check, LLC that markets PDI Check near vision game for the Nintendo 3DS. Dr Arnold reports non-financial support from Glacier Medical Software, non-financial support from PDI Check, non-financial support from Alaska Blind Child Discovery, outside the submitted work. In addition, Dr Arnold has a patent PDI Check pending to Robert Arnold and Alex Damarjian; and Protocol Developer and Investigator for the Pediatric Eye Disease Investigator Group (PEDIG); Non-paid advisory board for GoCheck Kids, PlusoptiX, iScreen, Adaptica. The authors report no other conflicts of interest in this work.

© 2019 Arnold and Bond.

Figures

Figure 1
Figure 1
Impact of proparacaine 1% added to post-strabismus antibiotic-steroid ointment in strabismus surgery classified as simple (routine virgin recession cases and inferior oblique myectomy) versus complex cases (recess/resect, transpositions, re-operations). Box plot surrounding middle quartiles with median and bars extend to range of outcomes.

References

    1. Meuwly C, Chowdhury T, Sandu N, et al. Definition and diagnosis of the trigeminocardiac reflex: a grounded theory approach for an update. Front Neurol. 2017;8:533. doi:10.3389/fneur.2017.00533
    1. Machida CJ, Arnold RW. The effect of induced muscle tension and fatigue on the oculocardiac reflex. Binoc Vis and Strabismus Quart. 2003;18(2):81–86.
    1. Stowman AM, Bothun ED, Belani KG. Discomfort, delirium, and PONV in infants and young children undergoing strabismus surgery. Minn Med. 2011;94(3):39–41.
    1. Ramachandran R, Rewari V, Chandralekha C, Sinha R, Trikha A, Sharma P. Sub-tenon block does not provide superior postoperative analgesia vs intravenous fentanyl in pediatric squint surgery. Eur J Ophthalmol. 2014;24(5):643–649. doi:10.5301/ejo.5000438
    1. Gupta N, Kumar R, Kumar S, Sehgal R, Sharma KR. A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra-operative and postoperative complications during paediatric strabismus surgery. Anaesthesia. 2007;62(11):1110–1113. doi:10.1111/ana.2007.62.issue-11
    1. Ibrahim AN, Shabana T. Sub-Tenon’s injection versus paracetamol in pediatric strabismus surgery. Saudi J Anaesth. 2017;11(1):72–76. doi:10.4103/1658-354X.197349
    1. Steib A, Karcenty A, Calache E, Franckhauser J, Dupeyron JP, Speeg-Schatz C. Effects of subtenon anesthesia combined with general anesthesia on perioperative analgesic requirements in pediatric strabismus surgery. Reg Anesth Pain Med. 2005;30(5):478–483. doi:10.1097/00115550-200509000-00010
    1. Seo IS, Seong CR, Jung G, Park SJ, Kim SY, Kim MM. The effect of sub-tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery. Eur J Anaesthesiol. 2011;28(5):334–339. doi:10.1097/EJA.0b013e3283426ed6
    1. Westerling D, Blohme J, Stigmar G. Orbital mass in a child causing somnolence, nausea and bradycardia. Can J Anaesth. 1998;45(8):777–780. doi:10.1007/BF03012148
    1. Negrutiu S, Pop R, Cardan E. Reflex oculocardiac persistent consecutiv unui hematom retrobulbar. Prezentare de caz. [Persistent oculocardiac reflex following retrobulbar hematoma. Case report]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1988;32(2):149–151.
    1. Blanc V, Ruest P, Brisson G, Jacob J-L. Serum gastrin and blood glucose levels during halothane-nitrous oxide anaesthesia and strabismus surgery in children. Can J Anaesth. 1991;38(1):43–48. doi:10.1007/BF03009162
    1. Kim J, Azavedo L, Bhananker S, Bonn G, Splinter W. Amethocaine or ketorolac eyedrops provide inadequate analgesia in pediatric strabismus surgery. Can J Anaesth. 2003;50(8):819–823. doi:10.1007/BF03019379
    1. Arnold RW, Biggs RE, Beerle BJ. Intravenous dexmedetomidine augments the oculocardiac reflex. J AAPOS. 2018;22(3):211–213.e211. doi:10.1016/j.jaapos.2018.01.016
    1. Watcha MF, Medellin E, Lee AD, Felberg MA, Bidani SA. Validation of the pictorial Baxter Retching Faces scale for the measurement of the severity of postoperative nausea in Spanish-speaking children. Br J Anaesth. 2018;121(6):1316–1322. doi:10.1016/j.bja.2018.07.036
    1. Tramér M, Fuchs-Buder T, Sansonetti A, Rifat K. Low incidence of the oculocardiac reflex and postoperative nausea and vomiting in adults undergoing strabismus surgery. Can J Anaesth. 1997;44(8):830–835. doi:10.1007/BF03013159
    1. Allen L, Sudesh S, Sandramouli S, Cooper G, McFarlane D, Willshaw H. The association between the oculocardiac reflex and post-operative vomiting in children undergoing strabismus surgery. Eye. 1998;12(2):193–196. doi:10.1038/eye.1998.46
    1. Stump M, Arnold RW. Iris color alone does not predict susceptibility to the oculocardiac reflex in strabismus surgery. Binocul Vis Strabismus Q. 1999;14(2):111–116.
    1. Arnold RW, Jensen PA, Kovtoun TA, Maurer SA, Schultz JA. The profound augmentation of the oculocardiac reflex by fast acting opioids. Binocul Vis Strabismus Q. 2004;19(4):215–222.
    1. Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol. 2019;19(1):36. doi:10.1186/s12871-019-0712-z

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다