Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.02.003
Brazilian Journal of Anesthesiology
Scientific Article

Effectiveness of sub-Tenon's block in pediatric strabismus surgery

Eficácia do bloqueio subtenoniano em cirurgia de estrabismo pediátrico

Kasim Tuzcu; Mesut Coskun; Esra Ayhan Tuzcu; Murat Karcioglu; Isil Davarci; Sedat Hakimoglu; Suzan Aydin; Selim Turhanoglu

http://dx.doi.org/10.1016/j.bjane.2014.02.003 Braz J Anesthesiol, vol.65, n5, p.349-352, 2015
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Abstract

ABSTRACTBACKGROUND AND OBJECTIVES: Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.METHODS: 40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n = 20), patients did not receive sub-Tenon's anesthesia. In group 2 (n = 20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.RESULTS: There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p > 0.05). Pain scores 30 min post-surgery were significantly lower in group 2 than in group 1 (p < 0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p < 0.05).CONCLUSIONS: In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.

Keywords

Sub-Tenon's block, Pediatric strabismus surgery, Anesthesia

Resumo

RESUMOJUSTIFICATIVA E OBJETIVO: A cirurgia de estrabismo é um procedimento oftalmológico comum em pediatria. Um grande problema que ocorre com frequência em pacientes submetidos a esse tratamento envolve o reflexo oculocardíaco. Esse reflexo está associado ao aumento da incidência de náusea, vômito e dor. O objetivo deste estudo foi investigar os efeitos do bloqueio subtenoniano sobre o reflexo oculocardíaco, a dor, a náusea e o vômito no período pós-operatório.MÉTODOS: Foram incluídos no estudo 40 pacientes entre 5-16 anos, estado físico ASA I-II, submetidos à cirurgia eletiva de estrabismo. Foram randomicamente alocados em dois grupos, com o método de envelope lacrado. No Grupo 1 (n = 20),pacientes não receberam bloqueio subtenoniano. No Grupo 2 (n = 20), após a intubação, o bloqueio subtenoniano foi feito no olho submetido à cirurgia. Uso de atropina, escores de dor, reflexo oculocardíaco e incidência de náusea e vômito foram comparados.RESULTADOS: Não houve diferença significativa entre os grupos em relação ao reflexo oculocardíaco e ao uso de atropina (p > 0,05). Os escores de dor em 30 minutos de pós-operatório foram significativamente menores no Grupo 2 do que no Grupo 1 (p < 0,05). A necessidade de analgésico adicional durante o período pós-operatório foi significativamente menor no Grupo 2 do que no Grupo 1 (p < 0,05).CONCLUSÕES: O bloqueio subtenoniano, em combinação com anestesia geral, não é eficaz e confiável para diminuir o reflexo oculocardíaco, bem como náusea e vômito pós-operatórios (NVPO). Porém, esse método é seguro para diminuir a dor no período pós-operatório e reduzir a analgesia adicional necessária em cirurgia de estrabismo pediátrico.

Palavras-chave

Bloqueio subtenoniano, Cirurgia de estrabismo pediátrico, Anestesia

References

McGoldrick KE, Gayer SI., Barash PG, Cullen BF, Stoelting RK. Anesthesia and the eye. 2006:974-96.

Blanc VF, Hardy JF, Milot J,. The oculocardiac reflex: a graphic and statistical analysis in infants and children. Can Anaesth Soc J. 1983;30:360-9.

Donlon JV, Doyle JDJ., Miller RD. Anesthesia for eye, ear, nose and throat surgery. 1990:2001-23.

Wier PM, Munro HM, Reynolds PI,. Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery. Anesth Analg. 1993;76:760-4.

Steib A, Karcenty A, Calache E,. Effects of subtenon anesthesia combined with general anesthesia on periopera- tive analgesic requirements in pediatric strabismus surgery. Reg Anesth Pain Med. 2005;30:478-83.

Suresh S, Wheeler M. Practical pediatric regional anesthesia. Anesthesiol Clin North Am. 2002;20:83-113.

Ghai B, Ram J, Makkar JK,. Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. Anesth Analg. 2009;108:1132-8.

Sethi S, Ghai B, Sen I,. Efficacy of subtenon block in infants - a comparison with intravenous fentanyl for perioper- ative analgesia in infantile cataract surgery. Paediatr Anaesth. 2013;23:1015-20.

Ates Y, Unal N, Cuhruk H,. 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,. Subtenons lidocaine injec- tion for postoperative pain relief after strabismus surgery in children: a pilot study. J AAPOS. 2003;7:38-41.

Subramaniam R, Subbarayudu S, Rewari V,. Usefulness of pre-emptive peribulbar block in pediatric vitreoretinal surgery: a prospective study. Reg Anesth Pain Med. 2003;28:43-7.

Chhabra A, Sinha R, Subramaniam R,. Comparison of sub- Tenon's block with i.v. fentanyl for paediatric vitreoretinal surgery. Br J Anaesth. 2009;103:739-43.

Rodriques-Coleman H, Spaide R. Ocular complications of nee- dle perforations during retrobulbar and peribulbar injections. Ophthalmol Clin North Am. 2001;14:573-9.

Parulekar MV, Berg S, Elston JS. Adjunctive peribulbar anaes- thesia for paediatric ophthalmic surgery: are the risks justified?. Paediatr Anaesth. 2002;12:85-6.

Wong DH. Regional anaesthesia for intraocular surgery. Can J Anaesth. 1993;40:635-57.

Troll GF. Regional ophthalmic anesthesia: safe techniques and avoidance of complications. J Clin Anesth. 1995;7:163-72.

Guise PA. Sub-tenon anesthesia: a prospective study of 6,000 blocks. Anesthesiology. 2003;98:964-8.

Anderson CJ. Circumferential perilimbal anesthesia. J Cataract Refract Surg. 1996;22:1009-12.

Mirakur RK, Clarke RS, Dundee JW,. Anticholinergic drugs in anaesthesia. A survey of their present position. Anaesthesia. 1978;33:133-8.

Ripart J, Metge L, Prat-Pradal D,. Medial canthus single-injection episcleral (sub-tenon anesthesia): computed tomography imaging. Anesth Analg. 1998;87:42-5.

Niemi-Murola L, Krootila K, Kivisaari R,. Localization of local anesthetic solution by magnetic resonance imaging. Oph- thalmology. 2004;111:342-7.

Sheard RM, Mehta JS, Barry JS,. Subtenons lidocaine injec- tion for postoperative pain relief after strabismus surgery in children: a prospective randomized controlled trial. J AAPOS. 2004;8:314-7.

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