Tags

Type your tag names separated by a space and hit enter

Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery.
Anesth Analg. 2009 Apr; 108(4):1132-8.A&A

Abstract

BACKGROUND

General anesthesia with opioids provides good operative conditions for ocular surgery in children; however, postoperative pain management remains a significant problem. Regional anesthesia is commonly used as an adjunct to general anesthesia in children. We compared the efficacy and safety of subtenon block (SB) versus IV fentanyl for perioperative analgesia in pediatric cataract surgery. We hypothesized that perioperative analgesia using SB may reduce the requirement of postoperative rescue analgesia compared with fentanyl.

METHODS

This was a prospective, randomized, controlled, double-blind trial. One hundred fourteen ASA I and II children (6 mo-6 yr) undergoing elective cataract surgery in one eye under general anesthesia were studied. Children were randomly allocated to one of the two groups, i.e., Group SB (n = 58) or Group F (n = 56) after securing the airway. Children in Group SB received SB with 0.06-0.08 mL/kg of 2% lidocaine and 0.5% bupivacaine (50:50) mixture and simultaneous 0.2 mL/kg normal saline IV, whereas children in Group F received 1 microg/kg (0.2 mL/kg of 5 microg/kg) of fentanyl IV and simultaneous subtenon injection with normal saline (0.06-0.08 mL/kg). Surgery started after 5 min of study drug administration. Postoperative assessment for pain, sedation, and nausea/vomiting was done at 0.5, 1, 2, 3, 4, and 24 h. The primary outcome was number of patients requiring rescue analgesia during the 24-h study period. Secondary outcomes assessed were pain and sedation scores, time to first rescue analgesia, incidence of occulocardiac reflex, and nausea/vomiting.

RESULTS

The number of patients requiring rescue analgesia during the 24 h was significantly less in Group SB (n = 17/58, 29.3%) compared with Group F (n = 39/56, 69.6%, P < 0.001). The postoperative pain scores were statistically lower in Group SB at all time intervals. The median (range) time to first analgesic requirement was significantly prolonged in Group SB (9 [corrected] [2-13] vs 4 [0.5-8.5] h in Group F) (P < 0.001). Sedation scores at (1/2) h were comparable, after which significantly more children were anxious or crying in Group F compared with Group SB in which more children were calm, sitting, or lying with eyes open and relaxed (P < 0.05). A significantly higher incidence of oculocardiac reflex was recorded in Group F versus Group SB (P = 0.019). No complication related to SB was noticed.

CONCLUSIONS

SB is a safe and superior alternative to IV fentanyl for perioperative analgesia in pediatric cataract surgery.

Authors+Show Affiliations

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19299775

Citation

Ghai, Babita, et al. "Subtenon Block Compared to Intravenous Fentanyl for Perioperative Analgesia in Pediatric Cataract Surgery." Anesthesia and Analgesia, vol. 108, no. 4, 2009, pp. 1132-8.
Ghai B, Ram J, Makkar JK, et al. Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. Anesth Analg. 2009;108(4):1132-8.
Ghai, B., Ram, J., Makkar, J. K., Wig, J., & Kaushik, S. (2009). Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. Anesthesia and Analgesia, 108(4), 1132-8. https://doi.org/10.1213/ane.0b013e318198a3fd
Ghai B, et al. Subtenon Block Compared to Intravenous Fentanyl for Perioperative Analgesia in Pediatric Cataract Surgery. Anesth Analg. 2009;108(4):1132-8. PubMed PMID: 19299775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subtenon block compared to intravenous fentanyl for perioperative analgesia in pediatric cataract surgery. AU - Ghai,Babita, AU - Ram,Jagat, AU - Makkar,Jeetinder Kaur, AU - Wig,Jyotsna, AU - Kaushik,Sushmita, PY - 2009/3/21/entrez PY - 2009/3/21/pubmed PY - 2009/4/9/medline SP - 1132 EP - 8 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 108 IS - 4 N2 - BACKGROUND: General anesthesia with opioids provides good operative conditions for ocular surgery in children; however, postoperative pain management remains a significant problem. Regional anesthesia is commonly used as an adjunct to general anesthesia in children. We compared the efficacy and safety of subtenon block (SB) versus IV fentanyl for perioperative analgesia in pediatric cataract surgery. We hypothesized that perioperative analgesia using SB may reduce the requirement of postoperative rescue analgesia compared with fentanyl. METHODS: This was a prospective, randomized, controlled, double-blind trial. One hundred fourteen ASA I and II children (6 mo-6 yr) undergoing elective cataract surgery in one eye under general anesthesia were studied. Children were randomly allocated to one of the two groups, i.e., Group SB (n = 58) or Group F (n = 56) after securing the airway. Children in Group SB received SB with 0.06-0.08 mL/kg of 2% lidocaine and 0.5% bupivacaine (50:50) mixture and simultaneous 0.2 mL/kg normal saline IV, whereas children in Group F received 1 microg/kg (0.2 mL/kg of 5 microg/kg) of fentanyl IV and simultaneous subtenon injection with normal saline (0.06-0.08 mL/kg). Surgery started after 5 min of study drug administration. Postoperative assessment for pain, sedation, and nausea/vomiting was done at 0.5, 1, 2, 3, 4, and 24 h. The primary outcome was number of patients requiring rescue analgesia during the 24-h study period. Secondary outcomes assessed were pain and sedation scores, time to first rescue analgesia, incidence of occulocardiac reflex, and nausea/vomiting. RESULTS: The number of patients requiring rescue analgesia during the 24 h was significantly less in Group SB (n = 17/58, 29.3%) compared with Group F (n = 39/56, 69.6%, P < 0.001). The postoperative pain scores were statistically lower in Group SB at all time intervals. The median (range) time to first analgesic requirement was significantly prolonged in Group SB (9 [corrected] [2-13] vs 4 [0.5-8.5] h in Group F) (P < 0.001). Sedation scores at (1/2) h were comparable, after which significantly more children were anxious or crying in Group F compared with Group SB in which more children were calm, sitting, or lying with eyes open and relaxed (P < 0.05). A significantly higher incidence of oculocardiac reflex was recorded in Group F versus Group SB (P = 0.019). No complication related to SB was noticed. CONCLUSIONS: SB is a safe and superior alternative to IV fentanyl for perioperative analgesia in pediatric cataract surgery. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19299775/Subtenon_block_compared_to_intravenous_fentanyl_for_perioperative_analgesia_in_pediatric_cataract_surgery_ L2 - http://dx.doi.org/10.1213/ane.0b013e318198a3fd DB - PRIME DP - Unbound Medicine ER -