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Usefulness of Pre-Emptive Peribulbar Block in Pediatric Vitreoretinal Surgery: A Prospective Study
  1. Rajeshwari Subramaniam, M.D.,
  2. Subramanyam Subbarayudu, M.D.,
  3. Vimi Rewari, M.D.,
  4. Rajendra P. Singh, M.S. and
  5. Rashmi Madan, M.D.
  1. From the Department of Anaesthesiology, All India Institute of Medical Sciences (R.S., S.S., V.R., R.M.), New Delhi; and the Department of Ophthalmic Surgery, Dr. Rajendra Prasad Centre for Ophthalmic Sciences (R.P.S.), New Delhi, India.
  1. Reprint requests: Rajeshwari Subramaniam, M.D., Rm No. 5010 - D, Teaching Block, Department of Anaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail: rajeshwarisubramaniam{at}


Background and Objectives Vitreoretinal (VR) surgery with or without scleral buckling is associated with significant postoperative pain and emesis in adults, and recent studies have addressed the effect of retro or peribulbar block on these parameters. VR surgery in children has received little attention regarding the incidence of pain and emesis, and the role of regional anesthesia in modifying these parameters. In this study, we compared peribulbar block with conventional opioid analgesia in children undergoing VR surgery.

Methods In a prospective, randomized, single-blind study, 85 children (ages 6 to 13 years) were allocated to receive peribulbar block (n = 42) or intravenous meperidine 1 mg/kg (n = 43) after induction of general anesthesia. Parameters compared were: intraoperative incidence of oculocardiac reflex and requirement for additional analgesic; postoperative pain intensity; incidence of postoperative emesis; time to first analgesic, total number of postoperative analgesic supplements; and parental assessment of the child’s postoperative comfort at 24 hours.

Results The incidence of intraoperative oculocardiac reflex was significantly less in the peribulbar group (P = .0001). Significantly more children receiving peribulbar block were pain free on awakening (P = .0004) and throughout the postoperative period. The number of children requiring opioid was significantly lower with peribulbar block (P = .008), and a significant number of children did not vomit throughout the postoperative period (P = .001).

Conclusions Peribulbar block appears to be a safe and clinically superior alternative to intravenous opioid for pediatric VR surgery. Reg Anesth Pain Med 2003;28:43-47.

  • Analgesia
  • Peribulbar block
  • Anesthesia
  • Pediatric
  • Surgery
  • Vitreoretinal

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  • This study was performed at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, which is the specialty Ophthalmic Services Department of the All India Institute of Medical Sciences.