title: A double-masked randomized trial of postoperative local anesthetic for pain control in pediatric strabismus surgery.
abstract: OBJECTIVE
  To determine to what extent local anesthetic reduces postoperative pain after pediatric strabismus surgery.
  
  
  METHODS
  In this double-masked, randomized clinical trial of 50 children 13-91 months of age undergoing strabismus surgery, subjects were randomly assigned to one of three treatments given at the conclusion of surgery: topical lidocaine gel and sub-Tenon's (balanced salt solution) placebo (n = 16), topical placebo (hypromellose) and sub-Tenon's bupivacaine 0.75% (n = 17), or topical and sub-Tenon's placebo (n = 17). Pain was otherwise managed systemically in the usual fashion by the masked anesthesia team and assessed at regular postoperative intervals by a masked observer using an objective, validated pain scale.
  
  
  RESULTS
  Average pain in the first 30 minutes was 6.57, 6.36, and 6.58 in the lidocaine, bupivacaine, and placebo groups, respectively, and was significantly lower (P = 0.016) for bupivacaine vs placebo. The bupivacaine group had significantly lower scores for pain after 30 minutes, total pain, and peak pain versus the lidocaine group.
  
  
  CONCLUSIONS
  Sub-Tenon's bupivacaine may reduce postoperative pain in children undergoing strabismus surgery.
authors.affiliation: Departments of Ophthalmology and Pediatrics, Duke University, Durham, North Carolina. Electronic address: laura.enyedi@duke.edu.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Enyedi
authors.affiliation: Departments of Ophthalmology and Pediatrics, Duke University, Durham, North Carolina.
authors.forename: David K
authors.initials: DK
authors.lastname: Wallace
authors.affiliation: Department of Anesthesiology, Duke University, Durham, North Carolina.
authors.forename: Guy
authors.initials: G
authors.lastname: de L Dear
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine; D002045:Bupivacaine