title: Effect of preemptive retrobulbar analgesia on perioperative hemodynamics and postoperative pain after enucleation.
abstract: OBJECTIVE
  To determine the preemptive pain and hemodynamic effects of preincisional retrobulbar analgesia in enucleation.
  
  
  METHODS
  This double-blinded, placebo-controlled study enrolled 69 patients scheduled for enucleation. Patients were stratified into two groups: those who used daily analgesics before surgery and those who did not. Each group was randomly assigned to receive a preincisional retrobulbar injection containing either a mixture of bupivacaine, lidocaine, epinephrine, and hyaluronidase; or saline placebo. All patients received postoperative retrobulbar injection containing the analgesic mixture. The outcome measures were intraoperative and postoperative blood pressure, heart rate, postoperative pain, and pain medication consumption.
  
  
  RESULTS
  Groups that received preincisional analgesia had a significantly lower mean intraoperative blood pressure (109/59 versus 127/69 mm Hg; P< 0.05). Visual analog scale pain assessment (VAS) was lower in both treatment groups upon recovery room entry (VAS, 0.3 versus 15.8, P=0.08) and after 30 minutes in the nonanalgesic use group (VAS, 5.6 versus 19.4, P=0.11). Among nonchronic analgesic users, fewer patients in the treatment group had pain requiring analgesic rescue in the recovery room (5% versus 25%, P=0.08). Postoperative pain medicine consumption in the first 24 hours did not differ significantly among the groups.
  
  
  CONCLUSIONS
  Preemptive retrobulbar analgesia was associated with improved intraoperative hemodynamics during enucleation and a trend toward reduced pain on entry in the recovery room and fewer pain rescues in the early postoperative period. A trend toward reduced pain severity in the early postoperative period was observed in those patients without daily preoperative analgesic use.
authors.affiliation: Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. pyeatts@wfubmc.edu
authors.forename: R Patrick
authors.initials: RP
authors.lastname: Yeatts
authors.forename: Wendy
authors.initials: W
authors.lastname: Doneyhue
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Scuderi
authors.forename: Chadwick R
authors.initials: CR
authors.lastname: Brasington
authors.forename: Robert
authors.initials: R
authors.lastname: James
mesh_terms: D000698:Analgesia; D000700:Analgesics / Q000008:administration & dosage; D004311:Double-Blind Method; D004338:Drug Combinations; D005123:Eye; D015353:Eye Enucleation; D006439:Hemodynamics; D006801:Humans; D007267:Injections; D007432:Intraoperative Period; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D012720:Severity of Illness Index
chemical_list: D000700:Analgesics; D004338:Drug Combinations