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    Reducing pain during postop pediatric strabismus surgery

    Multimodal approach is likely best; sub-Tenon’s bupivacaine may help lower pain levels

    Bupivacaine can reduce pain in children undergoing strabismus surgery, said Laura B. Enyedi, MD. She and her two co-authors, David K. Wallace, MD, MPH, and Guy de Lisle Dear, MBBCHIR, discussed the off-label use of anesthestic drugs in the pediatric population.

    In one study on strabismus surgery, Dr. Enyedi said upwards of 50% of pediatric patients “experience clinically significant pain” in the postop period.

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    “Pain is bad for the patient, for the healthcare system, and for the doctor,” she said. “It’s associated with discharge delays, contact after discharge, patient and parental dissatisfaction, as well as long-term post-operative behavioral changes.”

    The best pain control is a multimodal approach that consists of narcotics and non-narcotic pain relievers including nonsteroidal anti-inflammatories, acetaminophen, and local anesthetics, she said.

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    Previous randomized studies on the pediatric population have evaluated everything from drugs to delivery methods and used a variety of outcome measures. But with conflicting results, no clinical consensus has emerged to determine what benefit—if any—can be gleaned with local anesthetics on pain control.

    Dr. Enyedi’s group evaluated whether local anesthetics, either topical or sub-tenons, given at the end of strabismus surgery, reduce post-operative pain in children of ages 12 months to less than 8 years. The randomized, double-masked study enrolled 50 patients already scheduled for strabismus surgery at the Duke Eye Center (NC). Patients were randomly assigned to one of three groups: sub-tenons control with topical anesthetic, sub-tenons anesthetic with topical control, and a sub-tenons control with a topical control, she said. Of potential interest, the wounds were both fornix- and limbal-based.

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