Postoperative Behaviour after Primary Strabismus Surgery in Children: Is There an Influence of Intraoperative Topical Anaesthesia?

Abstract:

INTRODUCTION:The course of the recovery phase after general anaesthesia, during which consciousness and pain gradually return, is essentially determined by the choice of anaesthetic drug, and its total dose or duration of application. This phase is often complicated by more or less severe agitation, especially in children. In the present study we investigated whether the application of a topical anaesthetic to the conjunctiva at the end of a strabismus operation had a positive effect on the recovery behaviour of the child. PATIENTS/METHODS:This prospective, randomised, blinded study was conducted with 50 healthy, ASA class I or II children, aged 3 to 8 years undergoing their first strabismus operation. Following the surgeon's randomisation two drops of a 0,5% tetracaine-HCl ophthalmic solution were applied to the operated conjunctiva three times at 30-s intervals immediately following wound closure. The postoperative evaluation encompassed heart rate, as well as COMFORT and CHEOPS scores. The first assessment was directly postoperatively with repetitions at 15, 30, 45, 60, 75, 90 and 120 min, as well as on the day after surgery. RESULTS:The CHEOPS scores did not differ significantly between children with or without topical anaesthesia at any time during the observation period. The COMFORT scores revealed a slight, but non-significant analgesic effect at 15 and 30 min. The 60 min score showed the opposite effect, possibly indicating a slight disadvantage of the topical anaesthesia. There were no significant differences with regard to time to first request for additional systemic analgesia, to the total dose of systemic pain medication, or to when the patient was eligible for discharge to the ward. CONCLUSION:The application of topical tetracaine-HCl immediately after wound closure had no positive effects on the course of the postoperative recovery period after strabismus surgery in children. There was no evidence of an effect on pain or emergence agitation. HINTERGRUND:Die Dauer der Aufwachphase nach einer Allgemeinanästhesie, in der Bewusstsein, Kontaktfähigkeit und Schmerzempfinden allmählich wiederkehren, wird im Wesentlichen von der Art, der Dosis und der Applikationsdauer der verwendeten Narkosemittel bestimmt. Diese Phase ist, gerade bei Kindern, häufig von Schmerz und Agitation gekennzeichnet. In der vorliegenden Studie wurde untersucht, ob sich eine unmittelbar am Ende einer Augenmuskeloperation applizierte Oberflächenanästhesie positiv auf das Aufwachverhalten des Kindes auswirkt. PATIENTEN/METHODIK:Eingeschlossen in diese prospektive, randomisierte, verblindete Studie wurden 50 gesunde Kinder der ASA-Klassen I oder II im Alter von 3 bis 8 Jahren, bei denen eine erste Augenmuskeloperation durchgeführt wurde. Randomisiert wurden 3-mal im Abstand von je 30 s 2 Tropfen 0,5% Tetracain-Augentropfen in das/die operierte(n) Auge(n) gegeben. Die postoperative Beurteilung erfolgte anhand von CHEOPS- und COMFORT-Skalen unmittelbar postoperativ sowie nach 15, 30, 45, 60, 75, 90 und 120 min und am Folgetag der Operation. ERGEBNISSE:Die CHEOPS-Scores zeigten über den gesamten Beobachtungszeitraum keine signifikanten Unterschiede. Die COMFORT-Scores wiesen initial (15 und 30 min) auf leicht geringere Schmerzen und Agitation hin (statistisch nicht signifikant). Ab 60 min postoperativ ergaben sich eher stärkere Schmerzen, sodass ab dann ein Nachteil in der Applikation der zusätzlichen Tropfen gesehen werden kann. Es zeigte sich kein signifikanter Unterschied im Hinblick auf den Zeitpunkt der Anforderung oder die Dosis von zusätzlicher systemischer Schmerzmedikation oder bez. der notwendigen Verweildauer im Aufwachraum. SCHLUSSFOLGERUNG:Die zusätzliche Applikation eines Lokalanästhetikums (Tetracain-HCl) unmittelbar postoperativ erbringt keinen positiven Nutzen in Bezug auf die postoperative Aufwachphase nach Augenmuskeloperationen bei Kindern. Eine Reduktion von Schmerzen oder Agitation konnte nicht bewiesen werden.

journal_name

Klin Monbl Augenheilkd

authors

Karstädt N,Crozier TA,Horn M,Naxer S,Schittkowski MP

doi

10.1055/a-1260-3023

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

1194-1201

issue

10

eissn

0023-2165

issn

1439-3999

journal_volume

237

pub_type

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