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Effect of Preemptive Retrobulbar Analgesia on Perioperative Hemodynamics and Postoperative Pain After Enucleation

Yeatts, R. Patrick M.D.*†; Doneyhue, Wendy M.D.*; Scuderi, Phillip E. M.D.; Brasington, Chadwick R. M.D.*; James, Robert M.S.

Ophthalmic Plastic & Reconstructive Surgery: May 2004 - Volume 20 - Issue 3 - p 226-231
doi: 10.1097/01.IOP.0000124676.00980.94

Purpose: To determine the preemptive pain and hemodynamic effects of preincisional retrobulbar analgesia in enucleation.

Methods: This double-blinded, placebo-controlled study enrolled 69 patients scheduled for enucleation. Patients were stratified into two groups: those who used daily analgesics before surgery and those who did not. Each group was randomly assigned to receive a preincisional retrobulbar injection containing either a mixture of bupivacaine, lidocaine, epinephrine, and hyaluronidase; or saline placebo. All patients received postoperative retrobulbar injection containing the analgesic mixture. The outcome measures were intraoperative and postoperative blood pressure, heart rate, postoperative pain, and pain medication consumption.

Results: Groups that received preincisional analgesia had a significantly lower mean intraoperative blood pressure (109/59 versus 127/69 mm Hg; P< 0.05). Visual analog scale pain assessment (VAS) was lower in both treatment groups upon recovery room entry (VAS, 0.3 versus 15.8, P=0.08) and after 30 minutes in the nonanalgesic use group (VAS, 5.6 versus 19.4, P=0.11). Among nonchronic analgesic users, fewer patients in the treatment group had pain requiring analgesic rescue in the recovery room (5% versus 25%, P=0.08). Postoperative pain medicine consumption in the first 24 hours did not differ significantly among the groups.

Conclusions: Preemptive retrobulbar analgesia was associated with improved intraoperative hemodynamics during enucleation and a trend toward reduced pain on entry in the recovery room and fewer pain rescues in the early postoperative period. A trend toward reduced pain severity in the early postoperative period was observed in those patients without daily preoperative analgesic use.

Preemptive retrobulbar analgesia is associated with improved intraoperative hemodynamics and a trend toward reduced pain in the early postoperative period.

*Departments of Ophthalmology, †Otolaryngology, and ‡Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.

Accepted December 10, 2003.

Presented in part to the annual meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery, New Orleans, Louisiana, November 10, 2001.

The authors have no proprietary or financial interest related to this manuscript.

Address correspondence and reprint requests to Dr. R. Patrick Yeatts, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157–1033. E-mail

©2004The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.