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Tetracaine may ease postop pain, distress
Perioperative tetracaine drops reduced surgery-related pain in children after strabismus surgery, a study found.
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Pediatric patients who received topical tetracaine ophthalmic drops before and after strabismus surgery experienced less pain and postoperative agitation than those who received saline drops, according to a study by William Anninger, MD, and colleagues.
Dr. Anninger and colleagues found that applying tetracaine 1% reduced postoperative pain as well as emergence agitation, a term that refers to mental disturbances following anesthesia including hallucinations, confusion, moaning, delusions and involuntary physical activity.
“Anesthesiologists have tried multiple different medical cocktails to decrease emergence agitation with some success,” Dr. Anninger said. “But several reports have shown that (anesthesia) plays an important role in increasing emergence agitation. This leads us to our hypothesis that topical anesthetics, specifically 1% tetracaine HCl, will reduce the incidence and intensity of emergence agitation in the recovery room.”
Study design
To test their hypothesis, Dr. Anninger and colleagues enrolled 88 patients scheduled for strabismus surgery, aged 1 to 12 years, in a double-masked, controlled trial. The patients were randomly assigned to one of three groups: patients who received saline drops before and after surgery (group A); patients who received tetracaine 1% before surgery and saline drops after surgery (group B); and patients who received tetracaine 1% before and after surgery (group C).
Nurses recorded their observations of the patients in the post-anesthesia care unit using two scales: a behavior scale and a modified behavioral pain scale. The nurses completed emergence agitation evaluations in the recovery room at 5, 10, 15, 30 and 45-minute intervals.
Behavior scale
An emergence behavior scale was created for this study, according to Dr. Anninger.
“Children received a score of 1 if they were asleep or calm, 2 if they were slightly agitated or fussy, 3 if they were crying and 4 if they were thrashing and crying,” Dr. Anninger said.
Using the behavior scale, a higher percentage of patients in group A exhibited behaviors associated with emergence agitation, while patients in the two tetracaine groups tended to be more calm or asleep, he said.
Modified pain scale
Using a modified behavioral pain scale, patients were assessed a score of 0 to 10 for facial expression, level of crying and bodily movements. Patients who received scores of 5 or greater were considered to be in severe pain, and those who scored 7 or higher received rescue morphine.
“A higher percentage of patients in groups B and C received scores of less than 5 at 5, 10, 15 and 30 minutes,” Dr. Anninger said.
“This study suggests that perioperative 1% tetracaine drops can decrease emergence agitation in the recovery room,” he said.
“We feel it is a relatively inexpensive, time-efficient, simple and safe intervention," he said.
For more information:
- William Anninger, MD, can be reached at The Childrens Hospital of Philadelphia, Richard D. Wood Building, 1st Floor, 34th and Civic Center Blvd., Philadelphia, PA 19104 U.S.A.; +1-215-590-2791.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology and focuses on optics, refraction and contact lenses.
- Lauren Wolkoff is Executive Editor of OSN U.S. Edition.