The quest for effective pain control during suture adjustment after strabismus surgery: A study evaluating supplementation of 2% lidocaine with 0.4% ropivacaine

Howard Palte, Kara M Cavuoto, Lalitha Sundararaman, Steven Gayer, Joyce Schiffman, Hilda Capo

Research output: Contribution to journalArticle

Abstract

Purpose: To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures.

Methods: Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points.

Results: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7).

Conclusion: We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery.

Original languageEnglish
Pages (from-to)33-37
Number of pages5
JournalJournal of Pain Research
Volume8
DOIs
StatePublished - Jan 14 2015

Fingerprint

Social Adjustment
Strabismus
Lidocaine
Sutures
Visual Analog Scale
Pain
Anesthetics
Local Anesthetics
Double-Blind Method
ropivacaine
Analysis of Variance
Confidence Intervals

Keywords

  • Adjustable-suture strabismus surgery
  • Local anesthetic block
  • Postoperative ocular motility
  • Postoperative pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{2896c8452bdd472a959d14e2ae1cb3e9,
title = "The quest for effective pain control during suture adjustment after strabismus surgery: A study evaluating supplementation of 2{\%} lidocaine with 0.4{\%} ropivacaine",
abstract = "Purpose: To determine whether the addition of 0.4{\%} ropivacaine to the standard 2{\%} lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures.Methods: Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2{\%} lidocaine and Group B received 2{\%} lidocaine/0.4{\%} ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points.Results: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95{\%} confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7).Conclusion: We conclude that the 50:50 mixture of 2{\%} lidocaine with 0.4{\%} ropivacaine as compared to 2{\%} lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery.",
keywords = "Adjustable-suture strabismus surgery, Local anesthetic block, Postoperative ocular motility, Postoperative pain",
author = "Howard Palte and Cavuoto, {Kara M} and Lalitha Sundararaman and Steven Gayer and Joyce Schiffman and Hilda Capo",
year = "2015",
month = "1",
day = "14",
doi = "10.2147/JPR.S74587",
language = "English",
volume = "8",
pages = "33--37",
journal = "Journal of Pain Research",
issn = "1178-7090",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - The quest for effective pain control during suture adjustment after strabismus surgery

T2 - A study evaluating supplementation of 2% lidocaine with 0.4% ropivacaine

AU - Palte, Howard

AU - Cavuoto, Kara M

AU - Sundararaman, Lalitha

AU - Gayer, Steven

AU - Schiffman, Joyce

AU - Capo, Hilda

PY - 2015/1/14

Y1 - 2015/1/14

N2 - Purpose: To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures.Methods: Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points.Results: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7).Conclusion: We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery.

AB - Purpose: To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures.Methods: Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points.Results: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7).Conclusion: We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery.

KW - Adjustable-suture strabismus surgery

KW - Local anesthetic block

KW - Postoperative ocular motility

KW - Postoperative pain

UR - http://www.scopus.com/inward/record.url?scp=84921461260&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84921461260&partnerID=8YFLogxK

U2 - 10.2147/JPR.S74587

DO - 10.2147/JPR.S74587

M3 - Article

AN - SCOPUS:84921461260

VL - 8

SP - 33

EP - 37

JO - Journal of Pain Research

JF - Journal of Pain Research

SN - 1178-7090

ER -