Abstract
Purpose :
Postoperative pain relief after strabismus surgery is currently managed with systemic paracetamol and diclofenac administered by the anesthesiologists during the surgery. This is often combined with morphine, depending on the anesthesiologists preference and/or the post-operative pain score. Post-operative pain lengthens hospital stay; however, systemic analgesics have many side effects which may also lengthen hospital stay. In the Netherlands, there is no standard protocol for the administration of local anesthetic post-operatively. Therefore, we aimed to identify the various post-operative pain relief regimens applied by ophthalmologist.
Methods :
A questionnaire was designed and sent via e-mail to all ophthalmologists performing strabismus surgery in the Netherlands. The questionnaire inquired (1) if any local anesthetic was given before, during or after surgery (yes or no). The (2) location of the anesthetic (drops, sub-tenon or retrobulbar) and (3) type of anesthetic. The questionnaire applied to children and adults undergoing primary strabismus surgery or reoperations under general anesthesia.
Results :
Of the 54 ophthalmologists performing strabismus surgery in 32 clinics in the Netherlands, 38 (70%) completed the questionnaire. Of these, 59% reported not giving any local post-op pain relief. 24% Administered 1 drop of 0.4% oxybuprocaine onto the operated eye at the end of surgery; 10% administered 0.5 ml of 2% mepivacaine sub-tenon near the operated muscle(s) prior to closing the conjunctiva; and 4% injected 0.5 ml bupivacaine sub-tenon. Finally, 3% of the surgeons injected 0.5 ml of 2% lidocaine into the sub-tenon space.
Conclusions :
There is a large variety in the administered post-operative pain relief, even between surgeons working at the same clinic. Sufficient evidence exists that administering a local anesthetic reduces pain and may therefore reduce the necessity of additional systemic analgesia. This has prompted us to design a multi-center prospective randomized controlled trial to determine if the administration of 0.5 ml 2% mepivacaine sub-tenon just prior to conjunctival closure will reduce perceived pain scores measured with a newly developed PainScore App by the anesthesiologists.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.