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2 results

  • Chapter 27 - Anaesthesia for Ophthalmic Surgery in Children

  • Edited by James Ip, Great Ormond Street Hospital for Children, London, Grant Stuart, Great Ormond Street Hospital for Children, London, Isabeau Walker, Great Ormond Street Hospital for Children, London, Ian James, Great Ormond Street Hospital for Children, London
  • Book:
    Core Topics in Paediatric Anaesthesia
    Published online:
    06 February 2025
    Print publication:
    13 February 2025, pp 302-310

  • Summary

    Ophthalmic surgery takes place in children of all ages, from premature neonates to teenagers, the majority of whom are ASA 1 or 2. In some cases, the ocular pathology may be part of a wider congenital or metabolic abnormality and anaesthesia is not so straightforward. Nearly all will require general anaesthesia. Anxiety can be common in children returning for repeated procedures, and premedication may be necessary. Surgery can be extraocular or intraocular. Simple day-case procedures can usually be managed with an inhalational spontaneous breathing technique and supraglottic airway device (SAD). Certain more complex cases necessitate a completely still eye, and muscle relaxation is therefore usually required. Special anaesthetic considerations are management of the oculocardiac reflex (OCR), commonly elicited by traction on the recti muscles and prevention of postoperative nausea and vomiting (PONV); strabismus surgery is particularly emetogenic. The majority of ophthalmic surgery is not particularly painful, and simple analgesia with paracetamol and NSAIDs is sufficient. Regional ophthalmic blocks, such as sub-Tenons, can supplement or offer an alternative to opiates when additional analgesia is required. This has the added advantage of producing akinesis of the globe and a beneficial reduction in PONV and the OCR.

  • Levobupivacaine 0.75% vs. lidocaine 4% for topical anaesthesia: a clinical comparison in cataract surgery

  • A. Di Donato, C. Fontana, F. Lancia, K. Di Giorgio, S. Reali, A. Caricati
  • Journal:
    European Journal of Anaesthesiology / Volume 24 / Issue 5 / May 2007
    Published online by Cambridge University Press:
    01 May 2007, pp. 438-440
    Print publication:
    May 2007
  • Background

    The aim of this study was to compare the efficacy of topical levobupivacaine drops 0.75% vs. lidocaine drops 4% in cataract surgery.

    Methods

    We examined 203 patients undergoing cataract surgery by phacoemulsification. They were randomized into two groups: one received four drops of lidocaine 4% and the other received four drops of levobupivacaine 0.75%. The onset and offset times of sensory block were evaluated. Application, intraoperative and postoperative subjective pain was quantified by the patients using a verbal pain score. Complications, rates of supplemental anaesthesia, and the satisfaction of surgeon and patients were also recorded.

    Results

    The mean sensory onset and offset times were significantly higher for the levobupivacaine group (P < 0.01). Pain score was lower in the levobupivacaine group than in the lidocaine one and the difference was statistically significant at all stages (P < 0.01). The mean satisfaction scores of patients and surgeon were also statistically higher for levobupivacaine (P < 0.01). No significant differences for complications and rates of supplemental anaesthesia were found.

    Conclusions

    Topical levobupivacaine 0.75% shows the same efficacy and safety as lidocaine 4% in cataract surgery by phacoemulsification. There was an adequate block with a good level of satisfaction of surgeon and patients. Levobupivacaine 0.75% offers a new and acceptable choice for topical anaesthesia in cataract surgery.