title: Comparison of sub-Tenon's block with i.v. fentanyl for paediatric vitreoretinal surgery.
abstract: BACKGROUND
  Vitreoretinal (VR) surgery is associated with moderate to severe pain and significant postoperative nausea and vomiting (PONV). The study aimed to assess the effectiveness of sub-Tenon's block for providing perioperative analgesia in children undergoing VR surgery.
  
  
  METHODS
  In a randomized, observer-blinded trial, after obtaining institutional ethical committee approval and parental consent, 200 ASA grade I-II children aged 5-16 yr were allocated to receive either a sub-Tenon's block (Group SB) or 2 microg kg(-1) i.v. fentanyl (Group F) after induction of anaesthesia and topical anaesthesia of the conjunctiva with proparacaine 0.5% drops. Patients in Group F received fentanyl 0.5 microg kg(-1) and those in Group SB were given a corresponding volume of normal saline i.v. every hour from preloaded syringes. Increases in heart rate or mean arterial pressure by more than 20% of baseline were treated with additional 0.5 microg kg(-1) i.v. fentanyl boluses in both groups. The incidence of oculocardiac reflex (OCR), need for additional analgesics, postoperative pain, and PONV were recorded for the first 24 h after surgery.
  
  
  RESULTS
  More patients in Group F (47.96%) had moderate to severe pain in the first 24 h when compared with Group SB (31.36%) (P=0.023). The need for postoperative ibuprofen was higher in Group F (66.3%) compared with Group SB (47.95%) (P=0.012). The incidence of OCR was significantly higher in Group F (31.6%) compared with Group SB (5.1%) (P<0.001). The incidence of PONV was similar in both groups.
  
  
  CONCLUSIONS
  Sub-Tenon's block provides more effective analgesia than i.v. fentanyl for paediatric VR surgery.
authors.affiliation: Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. anjolie5@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Chhabra
authors.forename: R
authors.initials: R
authors.lastname: Sinha
authors.forename: R
authors.initials: R
authors.lastname: Subramaniam
authors.forename: P
authors.initials: P
authors.lastname: Chandra
authors.forename: D
authors.initials: D
authors.lastname: Narang
authors.forename: S P
authors.initials: SP
authors.lastname: Garg
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009407:Nerve Block / Q000379:methods*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D012024:Reflex, Oculocardiac / Q000187:drug effects; D012160:Retina / Q000601:surgery; D012591:Scleral Buckling / Q000009:adverse effects; D016037:Single-Blind Method; D014822:Vitreous Body / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl