title: Extraconal bupivacaine in scleral buckling procedures.
abstract: BACKGROUND
  Intraoperative retrobulbar bupivacaine injection provides effective analgesia after scleral buckling procedures performed under general anesthesia, but is associated with significant risks.
  
  
  METHODS
  The safety and analgesic efficacy of an extraconal technique using a blunt cannula was evaluated. Forty patients undergoing scleral buckling procedures with general anesthesia were randomized to intraoperative extraconal bupivacaine injection (bupivacaine group. n = 21) or to no such treatment (control group, n = 19). General anesthetic and postoperative analgesia regimens were standardized. Analgesia requirements, pain, nausea, and sedation levels were graded at four intervals the first 24 hours after surgery. Chemosis was assessed 1 day after surgery, and ocular motility was assessed at 1 day, 1 week, and subsequent review.
  
  
  RESULTS
  Maximum, 0 to 2-hour, and 4 to 6-hour pain levels were lower in the bupivacaine group than the control group (Wilcoxon rank sum, P < 0.005, < 0.005, < 0.01, respectively). Postoperative analgesia was required within the first 24 hours of surgery by all patients in the control group, but by only 12 of 21 patients (57%) in the bupivacaine group (Fisher's exact test, P = 0.001). Ptosis with minimal supraduction defect was noted at first postoperative examination in two patients who had undergone extraconal bupivacaine injection but resolved within 1 week. No other complication was encountered.
  
  
  CONCLUSIONS
  Intraoperative extraconal bupivacaine injection appears to be a safe and effective method for reducing pain and analgesia requirements after scleral buckling procedures performed under general anesthesia.
authors.affiliation: Moorfields Eye Hospital, London, England, United Kingdom.
authors.forename: R D
authors.initials: RD
authors.lastname: Bourke
authors.forename: J G
authors.initials: JG
authors.lastname: Dowler
authors.forename: P
authors.initials: P
authors.lastname: Heyworth
authors.forename: R J
authors.initials: RJ
authors.lastname: Cooling
authors.forename: C
authors.initials: C
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007267:Injections; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D011182:Postoperative Care; D011446:Prospective Studies; D012591:Scleral Buckling
chemical_list: D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D002045:Bupivacaine