title: The effect of sub-Tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery.
abstract: OBJECTIVE
  Sevoflurane is widely used for paediatric anaesthesia. However, many cases of emergence agitation after sevoflurane anaesthesia have been reported and pain was suggested as a major contributing factor. The purpose of this study was to evaluate the effect of sub-Tenon lidocaine injection on emergence agitation in children receiving sevoflurane or propofol-remifentanil anaesthesia.
  
  
  METHODS
  We enrolled 260 children, aged 4-10 years, who were scheduled for strabismus surgery, and randomized them to one of four groups: group SS, SL, BS, and BL. Anaesthesia was maintained with sevoflurane (SS, SL) or propofol-remifentanil infusion (BS, BL). At the end of surgery, the surgeon injected into the sub-Tenon space 1 ml of isotonic saline (SS, BS) or 2% lidocaine (SL, BL). Emergence behaviour was assessed in the post-anaesthesia care unit using a 5-point scoring scale (score 1, asleep; 2, awake and calm; 3, irritable or consolable crying; 4, inconsolable crying; and 5, severe restlessness). We defined a score of 4 or 5 as emergence agitation. The incidence of emergence agitation was analysed using χ² and Fisher's exact test.
  
  
  RESULTS
  The incidence of emergence agitation in group SL and BL was significantly lower compared to group SS and BS, respectively (P = 0.011, 0.019). The lidocaine-injected group showed significantly lower occurrence of emergence agitation (10.4%) than isotonic saline-injected group (27.2%; P = 0.001). Emergence agitation was significantly higher following sevoflurane (25.0%) than balanced anaesthesia (13.1%; P = 0.023).
  
  
  CONCLUSIONS
  The frequency of emergence agitation is significantly reduced by sub-Tenon lidocaine injection regardless of the modality of anaesthesia used.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yeungnam University Hospital, Daegu, Republic of Korea. isseo@med.yu.ac.kr
authors.forename: Il-Sook
authors.initials: IS
authors.lastname: Seo
authors.forename: Chae-Rim
authors.initials: CR
authors.lastname: Seong
authors.forename: Gul
authors.initials: G
authors.lastname: Jung
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Park
authors.forename: Sae Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Myung Mi
authors.initials: MM
authors.lastname: Kim
mesh_terms: D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000627:therapeutic use; D013508:Ophthalmologic Surgical Procedures; D010149:Postoperative Pain / Q000150:complications / Q000517:prevention & control; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000077208:Remifentanil; D000077149:Sevoflurane; D013285:Strabismus / Q000601:surgery
chemical_list: D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D008012:Lidocaine; D000077208:Remifentanil; D015742:Propofol