Paper 13

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Comparison of Preemptive Analgesic Effect of Retrobulbar Block and Intravenous Fentanyl in Pediatric Strabismus Surgery

Dina H. Hassanein, MD, FRCS; Fatma M. Nada; Ahmed M. Kamal Gomaa, MD; Mohammed A. Selim, MD
Pediatric Ophthalmology Department, Cairo University
Cairo, Egypt

Introduction:  The aim of this study was to compare the analgesic effect of the retrobulbar block with IV Fentanyl in children undergoing strabismus surgery.

Methods:  This prospective, randomized, interventional comparative study included 50 children eligible for elective strabismus surgery. They were enrolled from April 2016 to March 2017 and were randomly divided into two groups, group R (Retrobulbar Block group) and group F (IV Fentanyl group).  The primary outcome measure was the pain score using the FLACC score.  Secondary outcome measures were the incidence of postoperative nausea and/or vomiting and the rate of complications.

Results:  The study showed that the two groups were comparable concerning baseline characteristics: age, gender, ASA status and duration of anesthesia. The intraoperative monitoring was also comparable between both groups. |The FLACC score in both groups was lower than 0.5 at 30, 60, 120, 180, 240 and 360 minutes postoperatively.  However, the FLACC score was significantly higher in the Fentanyl group than in the Retrobulbar block group at 30 and 120 minutes postoperatively.  Moreover, it was insignificantly higher in the Fentanyl group than in the Retrobulbar block group at 60, 180, 240 and 360 minutes postoperatively.

Discussion:  During the postoperative period, no patient needed opioids in both groups.  However, two patients from the Fentanyl group received Paracetamol.

Conclusion:  The results of the current study prove that the retrobulbar block is beneficial in providing better analgesia and lowering the postoperative pain and the need for additional analgesics postoperatively with less sedation, less nausea & vomiting.

References:  Ghai B, Ram J, Makkar JK, et al. Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. Anesth Analg. 2009;108:1132-8.
Ates Y, Unal N, Cuhruk H, et al. Postoperative analgesia in children using preemptive retrobulbar block and local anes- thetic infiltration in strabismus surgery. Reg Anesth Pain Med. 1998;23:569-74.
Sheard RM, Mehta JS, Barry JS, et al. Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: a prospective randomized controlled trial. J AAPOS. 2004;8:314-7.

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