Wolverhampton SUMMARYA prospective study was performed to evaluate and com pare the effect of subconjunctival bupivacaine and top ical amethocaine on pain relief after strabismus surgery.A total of 40 children scheduled for elective operation were randomly allocated to receive either subconjunc tival bupivacaine or topical amethocaine at the end of surgery. Post-operative pain was evaluated using a four point assessment score. We show that both techniques provide good post-operative pain relief. We advocate that either could be used routinely in strabismus surgery although topical amethocaine is easier to administer.The provision of optimal post-operative analgesia for chil dren undergoing strabismus surgery is an important objec tive; post-operative pain is unpleasant and may have adverse physiological and psychological effects. Good pain relief will speed recovery, reduce post-operative emotional disturbance and may facilitate early discharge. 1Pain following many paediatric procedures can be effec tively treated by local or regional analgesic techniques,2 and often no other medication will be required. This avoids the side effects of narcotics, allowing the child to return rapidly to full activity after surgery.Recently, we reported3 that a long-acting anaesthetic, such as bupivacaine 0. 5% injected subconjunctivally at the conclusion of strabismus surgery, significantly reduces post-operative pain. In this paper we continue our inves tigation of the optimum peri operative analgesia after strabismus surgery in children. As topical amethocaine is used routinely to provide conjunctival anaesthesia in oph thalmic examination and surgery, we aimed to compare the effect of subconjunctival bupivacaine and topical ame thocaine on post-operative pain relief in strabismus sur gery in children. PATIENTS AND METHODSApproval for this study was granted by the Local District
A prospective study was performed to assess the effect of subconjunctival bupivacaine on pain relief following strabismus surgery. A total of 36 children were randomly allocated to receive either subconjunctival infiltration of bupivacaine or normal saline at the conclusion of surgery. Post-operative pain was evaluated using a 4-point assessment score. Subconjunctival bupivacaine provided significantly better post-operative pain relief (P < 0.001). We suggest that it could be used routinely in strabismus surgery, as it improves post-operative comfort thereby facilitating day case surgery.
(BrJ Ophthalmol 1992; 76: 532-533)
SUMMARYOne of the main aims of small incisions in cataract surgery is to reduce surgically induced astigmatism to a minimwn. A prospective study was set up to compare sutured with unsutured 6 mm scleral pocket frown incision wounds for phacoemulsification. Videokera tography was used to study the topographical changes induced by surgery. Two groups of 15 patients were allocated to have either sutured or unsutured 6 mm frown incisions for their phacoemulsification. Video keratography was performed 1 day pre-operatively, and repeated 6 weeks post-operatively. Statistical analysis of the resultant data is discussed. The results show a modest flattening in the vertical meridian in both groups of patients which was slightly larger in the unsutured group. The astigmatic change did not differ significantly between the two groups. The 6 mm scleral pocket incisions induce a small amount of astigmatism.whether sutured or unsutured. However, we felt it was perhaps safer to suture an incision of that size.Videokeratography is an invaluable tool for collection of outcome audit data, and allows for accurate graphical assessment of the effect of differing surgical approaches.Advances in surgical technique to minimise surgically induced astigmatism following cataract surgery require information on changes of the entire corneal shape. Computerised videokeratography (CVK) has recently provided valuable data on the changes to the whole of the corneal surface following cataract surgery.In this study we used CVK to evaluate the corneal topographic changes induced by sutured and unsu tured 6 mm scleral pocket incisions for cataract extraction by phacoemulsification and posterior chamber intraocular lens implantation.
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