Comparison of sub-Tenon's block with i.v. fentanyl for paediatric vitreoretinal surgery

• Published in: British journal of anaesthesia : BJA Vol. 103; no. 5; pp. 739 - 743
• Main Authors: Chhabra, A., Sinha, R., Subramaniam, R., Chandra, P., Narang, D., Garg, S. P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2009
• Subjects: Adolescent; anaesthesia; anaesthetic techniques; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Female; Fentanyl - administration & dosage; Humans; Injections, Intravenous; Male; Medical sciences; Nerve Block - methods; Ophthalmologic Surgical Procedures - adverse effects; ophthalmological; paediatric; Pain Measurement - methods; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Postoperative Nausea and Vomiting - etiology; Reflex, Oculocardiac - drug effects; regional; Retina - surgery; Scleral Buckling - adverse effects; Single-Blind Method; sub-Tenon's block; surgery; Vitreous Body - surgery; anaesthetic techniques, regional, sub-Tenon's block; surgery, ophthalmological; anaesthesia, paediatric; Human; Agonist; μ Opioid receptor; Fentanyl; Opiates; Narcotic analgesic; Surgery; Anesthesia; Phenylpiperidine derivatives; Child; Comparative study
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aep230

Background Vitreoretinal (VR) surgery is associated with moderate to severe pain and significant postoperative nausea and vomiting (PONV). The study aimed to assess the effectiveness of sub-Tenon's block for providing perioperative analgesia in children undergoing VR surgery. Methods In a randomized, observer-blinded trial, after obtaining institutional ethical committee approval and parental consent, 200 ASA grade I–II children aged 5–16 yr were allocated to receive either a sub-Tenon's block (Group SB) or 2 µg kg−1 i.v. fentanyl (Group F) after induction of anaesthesia and topical anaesthesia of the conjunctiva with proparacaine 0.5% drops. Patients in Group F received fentanyl 0.5 µg kg−1 and those in Group SB were given a corresponding volume of normal saline i.v. every hour from preloaded syringes. Increases in heart rate or mean arterial pressure by more than 20% of baseline were treated with additional 0.5 µg kg−1 i.v. fentanyl boluses in both groups. The incidence of oculocardiac reflex (OCR), need for additional analgesics, postoperative pain, and PONV were recorded for the first 24 h after surgery. Results More patients in Group F (47.96%) had moderate to severe pain in the first 24 h when compared with Group SB (31.36%) (P=0.023). The need for postoperative ibuprofen was higher in Group F (66.3%) compared with Group SB (47.95%) (P=0.012). The incidence of OCR was significantly higher in Group F (31.6%) compared with Group SB (5.1%) (P<0.001). The incidence of PONV was similar in both groups. Conclusions Sub-Tenon's block provides more effective analgesia than i.v. fentanyl for paediatric VR surgery.