title: Effects of subtenon anesthesia combined with general anesthesia on perioperative analgesic requirements in pediatric strabismus surgery.
abstract: OBJECTIVE
  Pediatric strabismus surgery leads to undesirable intraoperative and postoperative side effects that include pain, postoperative nausea and vomiting (PONV), and oculocardiac reflex (OCR). We hypothesized that subtenon anesthesia performed before the start of surgery and combined with general intravenous anesthesia would reduce these adverse effects.
  
  
  METHODS
  Forty children (2.5 to 6 years of age, ASA status I to II) were prospectively randomized to receive either subtenon bupivacaine 0.5% or a saline injection before the beginning of surgery in a double-blind manner. Perioperative analgesic requirements, pain scores (CHEOPS scale), hemodynamics, and incidence of OCR and PONV were compared.
  
  
  RESULTS
  Postoperative pain scores were lower (P < .001) at removal of the laryngeal mask and 30 minutes later in the bupivacaine group. Intraoperative and postoperative analgesic requirements were significantly reduced in this group (P < .01). The incidence of OCR and PONV were also significantly decreased (P < .01). Intraoperative values of blood pressure were significantly higher in the saline group at 20 minutes (P < .02).
  
  
  CONCLUSIONS
  We conclude that preoperative subtenon bupivacaine 0.5% compared with a saline injection contributed to reduction of perioperative pain and undesirable side effects in pediatric strabismus surgery performed under general anesthesia.
authors.affiliation: Department of Anesthesiology, 1 place de l'hôpital, Hôpital Civil, University Hospital, 67091 Strasbourg cedex, France. Annick.Steib@chru-strasbourg.fr
authors.forename: Annick
authors.initials: A
authors.lastname: Steib
authors.forename: Alain
authors.initials: A
authors.lastname: Karcenty
authors.forename: Elie
authors.initials: E
authors.lastname: Calache
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Franckhauser
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dupeyron
authors.forename: Claude
authors.initials: C
authors.lastname: Speeg-Schatz
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011446:Prospective Studies; D012024:Reflex, Oculocardiac / Q000187:drug effects; D012965:Sodium Chloride / Q000008:administration & dosage; D013285:Strabismus / Q000601:surgery*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D012965:Sodium Chloride; D002045:Bupivacaine