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Does Topical Proparacaine Improve Postoperative Comfort After Strabismus Surgery?

Authors Arnold RW, Bond AN

Received 10 September 2019

Accepted for publication 6 November 2019

Published 20 November 2019 Volume 2019:13 Pages 2279—2283

DOI https://doi.org/10.2147/OPTH.S230498

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Nicola Ludin

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Robert W Arnold,1 Aleah N Bond2

1Pediatric Ophthalmology and Strabismus, Alaska Children’s EYE & Strabismus, Anchorage, AK 99508, USA; 2Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27101, USA

Correspondence: Robert W Arnold
Pediatric Ophthalmology and Strabismus, Alaska Children’s EYE & Strabismus Address 3500 Latouche #280, AK 99508 Tel +1 907561-1917
Fax +1 907563-5373
Email eyedoc@alaska.net

Background: Strabismus surgery is often performed on children and adults as a quick-turnover, outpatient procedure under general anesthesia. Ideal methods to reduce post-operative pain and nausea are not yet perfected. We postulated that a simple topical anesthetic drop after surgery might help.
Methods: In a prospective study of oculocardiac reflex (OCR) and strabismus surgery, a cohort of ongoing patients either received proparacaine immediately post-op, or none. Co-variables were Intraoperative opioid and OCR, patient age, type of surgery. Several post-operative recovery outcome variables were prospectively monitored.
Results: Sixty strabismus surgery patients (age 15±22 years) received proparacaine 1% while another 80 (16.5±22 years) received none; both received topical antibiotic-steroid ointment. Pain and nausea (Likert scale) were not impacted by covariables complexity of case, age less than 3.5, OCR >33% drop, intraoperative opioid or neuro-status. Immediate post-op heart rate was lower if OCR >33% and if opioids used. Time until discharge was shorter in younger patients. Proparacaine did not impact outcome variables, except in patients younger than 3.5 years when post-op pain was worse.
Conclusion: Post-op topical anesthetic either produced no difference, or worsened post-op pain and recovery. This prospective study does not support the use of topical anesthetic drop to reduce post-strabismus pain and nausea.
Clinical trials registration: NCT03672435, Strabismus Recovery With Proparacaine and Oculocardiac Reflex (OCRprop).

Keywords: oculocardiac reflex, nausea and vomiting, anesthesia recovery, topical anesthetic

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