Subtenons lidocaine injection for postoperative pain relief after strabismus surgery in children: A prospective randomized controlled trial.
BACKGROUND
We previously reported a pilot study of the use of subtenons lidocaine after primary, unilateral strabismus surgery in children. This study suggested an association between subtenons lidocaine administration at the conclusion of surgery and a reduction of pain in the immediate postoperative period. As a result of this pilot study we performed a full-scale prospective, randomized controlled trial to fully evaluate the efficacy of this intervention.


METHODS
Children undergoing primary surgery or reoperations for strabismus were recruited. If randomized to the treatment group, 1 ml of 2% lidocaine was injected into the subtenons space of each operated eye, just prior to conjunctival closure. The child's parents, who were masked to the intervention, assessed pain over 4 h postoperatively using an objective pain-scoring tool. Pain scores were recorded on return to the ward (0 h, approximately 20 to 30 min after the completion of surgery) and at 1, 2, and 4 h later.


RESULTS
One hundred eleven children were recruited, of whom 91 (82.0%) underwent unilateral and 20 (18.0%) underwent bilateral surgery. Ninety operations (81.1%) were primary procedures and 21 (18.9%) were reoperations. Fifty-four children (48.6%) were randomized to the treatment group and 57 (51.4%) were randomized to the control group. A subtenons lidocaine injection was associated with a significant reduction in pain at the 0 h observation (P = 0.0056), and the total pain score over the 4-h postoperative period was significantly lower in the treatment group compared to controls (P = 0.0381). There was no difference between the groups with respect to the need for additional systemic analgesia (P = 0.307).


CONCLUSIONS
This study showed that an intraoperative injection of subtenons lidocaine is associated with a significant reduction in postoperative pain during the first postoperative hour for all types of childhood strabismus surgery. There was no difference between the groups in the need for systemic analgesia.
The Moorfields Eye Hospital, London, United Kingdom.
Richard M
RM
Sheard
Jodhbir S
JS
Mehta
John-S
JS
Barry
Catey
C
Bunce
Gillian G W
GG
Adams
D000698:Analgesia / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003238:Connective Tissue / Q000187:drug effects; D005205:Fascia / Q000187:drug effects; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D013285:Strabismus / Q000601:surgery*
D000779:Anesthetics, Local; D008012:Lidocaine