Topical tetracaine appears to ease pain, mental distress in children postop

KEYSTONE, Colo. — Pediatric patients with strabismus who received topical tetracaine ophthalmic drops before and after surgery experienced less pain and postoperative agitation than those who received saline drops, according to a study presented here.

William Anninger, MD, presented the findings here at the meeting of the American Association for Pediatric Ophthalmology and Strabismus.

Dr. Anninger and colleagues found that applying tetracaine 1% improved postoperative pain as well as emergence agitation, which refers to mental disturbances following anesthesia including hallucinations, confusion, moaning, delusions and involuntary physical activity.

The investigators hypothesized that emergence agitation leads to parental and medical team dissatisfaction and increased time spent in the recovery room. The symptoms are related to pain and, therefore, should be relievable with effective pain relief, they said.

Dr. Anninger enrolled 88 patients scheduled for strabismus surgery, aged 1 to 12 years, in a double-masked, controlled trial. The patients were randomized 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 those who received tetracaine 1% before and after surgery (Group C).

Nurses observed the patients in the post-anesthesia care unit using two scales: a behavior scale and a modified behavioral pain scale.

Using the behavior scale, a higher percentage of patients in Group A exhibited behaviors associated with emergence agitation, while patients in the tetracaine groups tended to be more calm or asleep, Dr. Anninger said.

Under the modified behavioral pain scale, patients were assessed a score of zero to 10 for their facial expression, level of crying and bodily movements. Patients who received scores of five or greater were considered to be in severe pain and those who scored seven or higher received morphine.

“A higher percentage of patients in groups B and C received scores of less than five, at 5, 10 and 30 minutes,” Dr. Anninger said.

He noted there was not a statistically significant difference between the groups in terms of total recovery room time, vomiting, morphine use or pain experienced at home.

Also, applying tetracaine before and after surgery displayed no clear benefit over applying it postoperatively alone, he said.

Dr. Anninger said he found the use of tetracaine to be simple, inexpensive and time efficient. His said his group incorporated it into their routine at the Children’s Hospital of Philadelphia.