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Abstract
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Background and Aims Enucleation surgery for retinoblastoma is painful. This study compared analgesic efficacy of peribulbar block as adjunct to general anaesthesia (GA) in children. Primary outcome was number of children having moderate to severe pain in 6hours post-surgery. Pain scores (2,6,12 & 24 hrs), perioperative fentanyl (intraoperative and 2 hours postoperative) requirement, time to first postoperative analgesic (TFPA), incidence of OCR and PONV were also assessed.
Methods Fifty-four children, aged 0 -10 years were randomised to the peribulbar(PB) or GA group. Post induction of anaesthesia, PB group children were administered peribulbar block using 0.3ml/kg,0.5% ropivacaine. Intraoperative increase in heart rate or mean arterial pressure 20% above baseline was treated with 0.5mcg/kg fentanyl boluses.
Results Number of children with moderate to severe pain was lesser in the PB group [9/29(31%) ] versus the GA group [13/25(52%)] in 6 postoperative hours. TFPA was shorter in GA group, but the difference was not significant, (table 1). Number of patients requiring intraoperative fentanyl and total perioperative fentanyl requirement was significantly lower in study group (Table 1). Significant tachycardia was observed on traction of eyeball during enucleation (p<0.05) in the GA versus PB group (figure 1). Pain scores at different time points, incidence of OCR and PONV were comparable between groups, (table 1).
Comparison of heart rate (per minute) at different time intervals between group PB and group GA
Conclusions The higher perioperative fentanyl administration in the GA group may have led to comparable pain scores between the two groups. The post-hoc analysis revealed the power of the study to be 78%, suggesting that further larger studies need to be carried out in the future.