Effect of peribulbar block on emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia

  • Jeetinder Kaur Makkar Post Graduate Institute of Medical Education and Research
  • Aswini Kuberan Post Graduate Institute of Medical Education and Research
  • Preet Mohinder Singh Post Graduate Institute of Medical Education and Research
  • Arun Magadi Gopinath Post Graduate Institute of Medical Education and Research
  • Kajal Jain Post Graduate Institute of Medical Education and Research
  • Jaspreet Singh Post Graduate Institute of Medical Education and Research
  • Narinder Pal Singh Post Graduate Institute of Medical Education and Research
Keywords: agitation, children, anaesthesia, strabismus surgery, peribulbar block

Abstract

Background: Strabismus surgery in children may be associated with a high incidence of emergence agitation that may be related to pain and visual disturbances. The objective was to evaluate the effect of peribulbar block on the incidence of emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia.

Methods: Fifty-six healthy children aged 2–10 years, undergoing strabismus surgery under general anaesthesia, were recruited. Children were randomly allocated to receive fentanyl 2 μg/kg (Group F) or peribulbar block (Group PB) with 0.3 ml/kg of 0.25% bupivacaine + 2% lignocaine. The primary outcome of the study was incidence of emergence agitation; secondary outcome measures were time to first rescue analgesia, the incidence of oculocardiac reflex and vomiting.

Results: Of 52 children, 14/25 (56%) children in Group F developed emergence agitation compared with 3/27 (11.11%) in group PB (p = 0.001). Postoperatively, the paediatric anaesthesia emergence delirium scores showed significantly lower emergence agitation in the PB group with a median (IQR) of 0.00 (0.00–2.00) compared with group F (5.5 (0.75–8.75) at all time intervals (p = 0.003 Mann–Whitney test). Pain scores were comparable between groups (group F 48% vs. group PB 25.9%). The time to first rescue analgesia was increased in group PB (126.875 ± 38.22 min vs. 88.08 ± 28.48 min in group F). The oculocardiac reflex occurred in 7/25 in Group F compared with 1/27 in Group PB (p = 0.015). There was no difference in the incidence of postoperative vomiting (24% in Group F vs. 22% in Group PB). 

Conclusion: Use of peribulbar block in children undergoing strabismus surgery under desflurane anaesthesia was associated with reduced incidence of emergence agitation and oculocardiac reflex but did not significantly increase the time to first analgesic or the incidence of pain and vomiting. A sub-tenon block may be safer and provide better operating conditions and equal analgesia.

Full text available online at South Afr J Anaesth Analg 2018; DOI: 10.1080/22201181.2018.1506645

Author Biographies

Jeetinder Kaur Makkar, Post Graduate Institute of Medical Education and Research

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Aswini Kuberan, Post Graduate Institute of Medical Education and Research

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Preet Mohinder Singh, Post Graduate Institute of Medical Education and Research

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Arun Magadi Gopinath, Post Graduate Institute of Medical Education and Research

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Kajal Jain, Post Graduate Institute of Medical Education and Research

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Jaspreet Singh, Post Graduate Institute of Medical Education and Research

Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Narinder Pal Singh, Post Graduate Institute of Medical Education and Research

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and Department of Anesthesia, Health Sciences Centre, University of Manitoba, Winnipeg, Canada

Published
2018-10-16
Section
Research Articles