Pain score assessment in babies undergoing laser treatment for retinopathy of prematurity under sub-tenon anaesthesia.
OBJECTIVE
To assess the tolerability and outcomes of laser treatment for retinopathy of prematurity (ROP) under sub-tenon anaesthetic with oral or rectal sedation using a reliable, multidimensional, and internationally accepted tool for assessment of neonatal pain.


METHODS
Sixty-two babies have had ROP laser treatment in our neonatal unit in the 7-year interval between 1 March 2005 and 28 February 2012; 44% (27 of the 62) were performed using sub-tenon anaesthesia. Pain scores were routinely assessed using the Neonatal Pain Agitation and Sedation Scale (N-PASS) every 10 min during laser treatment. The outcome and requirement for re-treatment in this group was compared with that in the intravenous sedation group.


RESULTS
Pain scores were available in 19 of the 27 babies treated under sub-tenon anaesthesia. The mean pain score during treatment was 2.7 (SD ± 1.7, range 0.5-6.2). There was no statistically significant correlation between the mean pain score and duration of treatment (Spearman correlation coefficient (ρ) = 0.31; P = 0.09), number of laser burns (ρ = 0.32; P = 0.09), or post-menstrual age of the baby at the time of treatment (ρ = 0.38; P = 0.052). Treatments performed under sub-tenon anaesthesia were as successful as those performed under intravenous sedation. The mean pain scores during laser treatment under sub-tenon anaesthesia in our study were lower than those previously reported during ROP screening or heel-stick procedure.Conclusion Our study demonstrated that sub-tenon anaesthesia with oral or rectal sedation provides sufficient pain control for laser treatment for ROP without the need or risks of intravenous sedation and intubation.
Ophthalmology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
E S
ES
Novitskaya
Ophthalmology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
V
V
Kostakis
Neonatal Department, Rosie Maternity Hospital, Cambridge, UK.
S C
SC
Broster
Ophthalmology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
L E
LE
Allen
D000082:Acetaminophen / Q000008:administration & dosage; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D001724:Birth Weight; D002697:Chloral Hydrate / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods; D058447:Eye Pain / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D017075:Laser Coagulation; D010147:Pain Measurement; D012178:Retinopathy of Prematurity / Q000601:surgery*; D058475:Tenon Capsule; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D000082:Acetaminophen; D002697:Chloral Hydrate