Abstract
Introduction The course of the recovery phase after general anaesthesia, during which consciousness
and pain gradually return, is essentially determined by the choice of anaesthetic
drug, and its total dose or duration of application. This phase is often complicated
by more or less severe agitation, especially in children. In the present study we
investigated whether the application of a topical anaesthetic to the conjunctiva at
the end of a strabismus operation had a positive effect on the recovery behaviour
of the child.
Patients/Methods This prospective, randomised, blinded study was conducted with 50 healthy, ASA class
I or II children, aged 3 to 8 years undergoing their first strabismus operation. Following
the surgeonʼs randomisation two drops of a 0,5% tetracaine-HCl ophthalmic solution
were applied to the operated conjunctiva three times at 30-s intervals immediately
following wound closure. The postoperative evaluation encompassed heart rate, as well
as COMFORT and CHEOPS scores. The first assessment was directly postoperatively with
repetitions at 15, 30, 45, 60, 75, 90 and 120 min, as well as on the day after surgery.
Results The CHEOPS scores did not differ significantly between children with or without topical
anaesthesia at any time during the observation period. The COMFORT scores revealed
a slight, but non-significant analgesic effect at 15 and 30 min. The 60 min score
showed the opposite effect, possibly indicating a slight disadvantage of the topical
anaesthesia. There were no significant differences with regard to time to first request
for additional systemic analgesia, to the total dose of systemic pain medication,
or to when the patient was eligible for discharge to the ward.
Conclusion The application of topical tetracaine-HCl immediately after wound closure had no
positive effects on the course of the postoperative recovery period after strabismus
surgery in children. There was no evidence of an effect on pain or emergence agitation.
Key words
eye muscle surgery - surface anaesthesia - postoperative behaviour - PONV - CHEOPS
- COMFORT
