Sub-Tenon's ropivacaine block for pain relief after primary strabismus surgery.
OBJECTIVE
Pain is the main cause of patient distress/dissatisfaction after strabismus surgery. The aim of the study was to evaluate the effect of sub-Tenon's block with ropivacaine at the end of strabismus surgery on post-operative pain.


METHODS
A prospective trial was conducted in 79 patients (age 1.0-65 years) scheduled for outpatient primary strabismus surgery with fixed sutures under general anesthesia (GA) at a major tertiary hospital. Half the patients were randomly allocated to receive sub-Tenon's block with ropivacaine 0.2% at conclusion of the operation. Primary outcome measures were visual analog scale (VAS) scores at arrival to the post-anesthesia care unit (PACU), at discharge 3 hr later, 12-16 hr post-operatively, and 24 hr post-operatively. Supplemental analgesia requirements and patient satisfaction were recorded as well. Data were presented as median (range). Mann-Whitney test, Pearson chi(2)-test or Fisher's exact test was used for statistical analysis; p <or= 0.05 was considered significant.


RESULTS
There were no between-group differences in median VAS scores at arrival to the PACU and at discharge, with a borderline difference at 24 hr post-operatively (p = 0.06). At 12-16 hr post-operatively, the median score was 0.0 (range 0-5) in the study group and 4.0 (range 0-6) in the controls (p < 0.001). The lower VAS score in the study group was associated with a lower rate of supplemental analgesia use (21.9% versus 57.9%, p = 0.001), fewer doses of supplemental analgesia (10 doses versus 35, p = 0.03), and higher patient satisfaction (p < 0.001).


CONCLUSIONS
Sub-Tenon's block with ropivacaine 0.2% at the completion of outpatient primary strabismus surgery with fixed sutures under GA reduces pain 12-16 hr post-operatively and analgesia requirements 4-23 hr post-operatively.
Kachko
Ludmyla
L
Department of Anesthesia, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel. kachko_l@hotmail.com
Katz
Jacob
J
Axer-Siegel
Ruth
R
Friling
Ronit
R
Goldenberg-Cohen
Nitza
N
Simhi
Eliahu
E
Ehrenberg
Miriam
M
Snir
Moshe
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000577:Amides / Q000008:administration & dosage*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003238:Connective Tissue; D005123:Eye; D005260:Female; D006801:Humans; D007223:Infant; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D017060:Patient Satisfaction; D000077212:Ropivacaine; D013285:Strabismus / Q000601:surgery*; D013537:Sutures; D055815:Young Adult
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine