Does Topical Proparacaine Improve Postoperative Comfort After Strabismus Surgery?

Abstract

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

Data Sharing Statement

Deidentified data: http://www.abcd-vision.org/OCR/OCR proparacaine de-identified.pdf.

Disclosure

Dr. Arnold is a board member of Glacier Medical Software that markets ROP-Check NICU software and of PDI Check, LLC that markets PDI Check near vision game for the Nintendo 3DS. Dr Arnold reports non-financial support from Glacier Medical Software, non-financial support from PDI Check, non-financial support from Alaska Blind Child Discovery, outside the submitted work. In addition, Dr Arnold has a patent PDI Check pending to Robert Arnold and Alex Damarjian; and Protocol Developer and Investigator for the Pediatric Eye Disease Investigator Group (PEDIG); Non-paid advisory board for GoCheck Kids, PlusoptiX, iScreen, Adaptica. The authors report no other conflicts of interest in this work.

Additional information

Funding

Self funded.