EFFICACY OF SUB-TENON'S BLOCK IN PAEDIATRIC STRABISMUS SURGERY IN TERMS OF REDUCTION IN OCULOCARDIAC REFLEX
DOI:
https://doi.org/10.55519/JAMC-01-11512Keywords:
Strabismus, sub-Tenon’s block, Oculocardiac reflexAbstract
Background: Strabismus is a common disease entity in paediatric age group usually requiring surgical intervention under general anaesthesia and Oculocardiac reflex is the most dangerous complications intraoperatively. Various anaesthetic options have been evaluated to mitigate this complication. The objective of this study was to assess the efficacy of sub-tenon's block in paediatric strabismus surgery in terms of reduction in oculocardiac reflex. Methods: This prospective Randomized control trial was conducted at Department of ophthalmology, MTI, Hayatabad Medical complex, Peshawar over a period of six months from 1st July to 31st December 2021. A total of 124, were equally divided in sub-tenon's group (Group A) and placebo group (Group B). Intraoperatively, patients were assessed for Bradycardia and development of OCR. Data including demographics, intraoperative BP, HR and OCR development were noted and analysed with SPSS version 22. Results: The total number of patients were 124, 62 in each group with a mean age of 9.45±1.61. Sixty-six (53.22%) patients were males and 58 (46.87%) patients were females. At 10-, 20- and 30-minutes interval, the SBP and DBP has no significant difference. At 10, 20, 30 minutes interval, the HR differed significantly (79.33±7.36 vs 66.65±6.83 (pË‚0.05), 79.78±7.63 vs 66.57±7.06 (pË‚0.05), 79.80±7.78 vs 66.52±7.01 (pË‚0.05), respectively. Intraoperative OCR was recorded in 13 (21%) patients in sub-tenon's (Group A) versus 56 (90.30%) patients in placebo (Group B) with statistically significant difference between the two (p<0.05). Conclusion: Sub-tenon's injection of bupivacaine reduces the incidence of Bradycardia and OCR in squint surgery patients after general anaesthesia induction and usage is recommended in routine.
References
Chua AW, Chua MJ, Leung H, Kam PC. Anaesthetic considerations for strabismus surgery in children and adults. Anaesth Intensive Care 2020;48(4):277-88.
Abbas S, Zafar O, Awais M, Abbas B, Hayat U, Mehmood B. Efficacy of topical anaesthesia in reduction of oculocardiac reflex during squint surgery. Pak Armed Forces Med J 2020;70(3):855-61.
Gujjula S, Chakrapani K, Harsha N, Karanam S, Nambula S. Occurrence of oculo cardiac reflex during strabismus surgery. Off Sci J Delhi Ophthalmol Soc 2019;30(1):28-31.
Ibrahim AN, Shabana T. Sub-Tenon's injection versus paracetamol in paediatric strabismus surgery. Saudi J Anaesth 2017;11(1):72-6.
Elgebaly AS. Sub-Tenon's lidocaine injection improves emergence agitation after general anaesthesia in paediatric ocular surgery. South Afr J Anaesth Analg 2013;19(2):114-9.
Arnold RW. The Oculocardiac Reflex: A Review. Clin Ophthalmol 2021;15:2693-2725.
Taghavi Gilani M, Sharifi M, Najaf Najafi M, Etemadi Mashhadi MG. Oculocardiac reflex during strabismus surgery. Rev Clin Med 2016;3(1):4-7.
Shin SY, Kim MJ, Joo J. Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anaesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: a retrospective study. J Int Med Res 2020;48(8):0300060520945158.
Arnold RW, Rinner AR, Arnold AW, Beerle BJ. The Impact of Re-Operation, Relatives and Race on the Oculocardiac Reflex During Strabismus Surgery. Clin Ophthalmol 2020;14:4253-61.
Paciuc-Beja M, Meizner-Grezemkovsky D, Paciuc M, Sanchez-Santos I, Ruiz-Roman A, Fack A, et al. Oculocardiac reflex during intravitreal injection. Med Hypothesis Discov Innov Ophthalmol 2020;9(2):111-7.
Okülokardiyak PŞ. Factors Affecting Oculocardiac Reflex Incidence In Paediatric Strabismus Surgery: retrospective Study. Group 2021;3:4.
Ha SG, Huh J, Lee BR, Kim SH. Surgical factors affecting oculocardiac reflex during strabismus surgery. BMC Ophthalmol 2018;18(1):1-5.
Rahimi Varposhti M, Moradi Farsani D, Ghadimi K, Asadi M. Reduction of oculocardiac reflex with Tetracaine eye drop in strabismus surgery. Strabismus 2019;27(1):1-5.
Choi SR, Park SW, Lee JH, Lee SC, Chung CJ. Effect of different anaesthetic agents on oculocardiac reflex in paediatric strabismus surgery. J Anesth 2009;23(4):489-93.
Yi C, Jee D. Influence of the anaesthetic depth on the inhibition of the oculocardiac reflex during sevoflurane anaesthesia for paediatric strabismus surgery. Br J Anaesth 2008;101(2):234-8.
Talebnejad MR, Khademi S, Ghani M, Khalili MR, Nowroozzadeh MH. The Effect of Sub'‘Tenon's Bupivacaine on Oculocardiac reflex during Strabismus Surgery and Postoperative Pain: A Randomized Clinical Trial. J Ophthalmic Vis Res 2017;12(3):296-300.
Tuzcua K, Coskun M, Tuzcu EA, Karcioglu M, Davarci I, Hakimoglu S, et al. Effectiveness of sub-Tenon's block in paediatric strabismus surgery. Rev Bras Anestesiol 2015;65(5):349-52.
Bakr RH, Abdelaziz HM. Subtenon bupivacaine injection for postoperative pain relief following paediatric strabismus surgery: A randomized controlled double blind trial. Middle East J Anaesthesiol 2016;23(1).91-9.
Gilani SM, Jamil M, Akbar F, Jehangir R. Anticholinergic premedication for prevention of oculocardiac reflex during squint surgery. J Ayub Med Coll Abbottabad 2005;17(4):57-9.
Sajedi P, Nejad MS, Montazeri K, Baloochestani E. Comparing the preventive effect of 2 percent topical lidocaine and intravenous atropine on oculocardiac reflex in ophthalmological surgeries under general anaesthesia. Int J Prev Med 2013;4(11):1258-65.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Noor ul Hussain, Muhammad Naeem Khan
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
