Postoperative analgesia in children using preemptive retrobulbar block and local anesthetic infiltration in strabismus surgery

Reg Anesth Pain Med. Nov-Dec 1998;23(6):569-74.


Background and objectives: Postoperative pain management in pediatric strabismus patients is infrequently studied. Pediatric patients can be mobilized earlier if postoperative pain is minimized. In this study, two different regional anesthetic techniques, retrobulbar block and local infiltration, were compared with a "no block" control group for the postoperative management of pain in pediatric patients undergoing elective strabismus surgery.

Methods: Thirty patients were randomly allocated to one of the study groups: group 1 (n=10) control, group 2 (n=10) retrobulbar block, and group 3 (n=10) subconjunctival bupivacaine infiltration. The parameters that were evaluated during the early postoperative period (6 hours) were circulatory, pain scores by Visual Analog Scale (VAS) and Modified Pediatric Objective Pain Scale (MPOPS), additional analgesic requirement, nausea, and vomiting. The parameters that were evaluated after discharge from the hospital (on postoperative days 1 and 2) through questionnaires were additional analgesic requirement, nausea, vomiting, sleep disturbances, activity, and appetite.

Results: Group 3 had significantly higher VAS and MPOPS scores at postoperative 120, 180, 240, 300, and 360 minutes than groups 1 and 2 (P < .05). Patients in group 2 seemed to have a higher incidence of nausea and vomiting both in the early (6 hours) and late postoperative (postoperative days 1 and 2) periods; however, the difference was not statistically significant. Group 2 required less analgesic compared with groups 1 and 3 during the late postoperative period. Late postoperative activity and appetite were better in groups 2 and 3.

Conclusions: Because there was no significant difference in terms of postoperative analgesia in the retrobulbar block or subconjunctival local anesthetic infiltration groups compared with the control group, we suggest that conventional methods of pain treatment are adequate for postoperative analgesia in strabismus surgery.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Analgesia / methods*
  • Analgesics / administration & dosage
  • Analgesics / therapeutic use
  • Anesthesia, Local / methods*
  • Anesthetics, Local / administration & dosage*
  • Appetite / drug effects
  • Bupivacaine / administration & dosage
  • Child
  • Child, Preschool
  • Conjunctiva
  • Early Ambulation
  • Elective Surgical Procedures
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Nerve Block*
  • Orbit / innervation*
  • Pain Measurement
  • Pain, Postoperative / prevention & control*
  • Patient Discharge
  • Postoperative Nausea and Vomiting / etiology
  • Sleep Wake Disorders / etiology
  • Strabismus / surgery*
  • Surveys and Questionnaires


  • Analgesics
  • Anesthetics, Local
  • Bupivacaine