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S.L. Merbs, M.P. Grant, N.T. Iliff; Use of Outpatient Pain-Control Catheter in Enucleation . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2221.
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Purpose: To examine the effectiveness of an indwelling, orbital catheter, placed at the time of enucleation, for repeatable delivery of local anesthetic at home as an outpatient. Methods: In a retrospective, non-comparative case series, we evaluated 67 consecutive patients undergoing enucleation by the authors on an outpatient basis, over a three-year period from January 1998 through December 2001. These patients received an indwelling, orbital pain-control catheter at the time of surgery and were given two syringes with local anesthetic and instructions for injection through the catheter to be used as needed for pain. The patients were also given a prescription for an oral narcotic. Catheters were left in place for 2-5 days. Charts were reviewed for patient and family comments regarding the catheter as to ease of use, degree and duration of pain control, and discomfort associated with injections. Results: Fifty-eight of the 67 patients (87%) reported using the catheter at home and none of the patients using the catheter reported any difficulty with its use. Eight of the 10 patients who did not use the catheter had no post-operative pain requiring catheter use. Ten of 58 patients (17%) using the catheter reported discomfort associated with catheter use, ranging from "feeling funny" to "slight burning", but in no case did the patient discontinue catheter use because of the discomfort. Five patients reported postoperative nausea, one specifically associated with narcotic use and one with the catheter injection. All patients who used the catheter felt pain relief lasting 1 ½ to greater than 4 hours. No post-operative complications associated with catheter placement, including post-operative hemorrhage, were observed. Conclusions: Many patients undergoing enucleation require post-operative pain management, either inpatient intramuscular narcotic delivery or outpatient oral narcotic analgesia. The pain-control catheter provides an effective addition to oral narcotic analgesia in the outpatient treatment of post-operative pain following enucleation with minimal side effects.
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