Does Topical Proparacaine Improve Postoperative Comfort After Strabismus Surgery?

Robert W Arnold,¹ Aleah N Bond<sup>2

1</sup>Pediatric 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