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Postoperative Analgesia for Eye Surgery

Clinician's Brief (Capsule)

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With eye enucleation, it is critical to control postoperative pain in patients to prevent postoperative complications from face rubbing or self-mutilation. This study compared lidocaine–bupivacaine retrobulbar injections given before enucleation vs lidocaine–bupivacaine infused gelatin hemostatic sponges in the orbit after enucleation for management of postoperative pain. Premedication consisted of hydromorphone, midazolam, and glycopyrrolate. Postextubation pain scores, recorded intermittently for the first 24 hours, were compared with preoperative pain scores. Significant differences were noted with respect to comfort level, response to touch, heart rate, and pain score in individual dogs over time; however, there was no significant difference between groups. One of 8 dogs in the absorbable gelatin hemostatic sponge group required rescue analgesia and none was required in the injection group (n = 11). There were no postoperative complications.

Commentary

Perioperative analgesia’s impact on patient well-being extends beyond the immediate perioperative period. Thus, appropriate pain management is a critical component of any anesthetic plan. This study’s technique offers an easy-to-perform means of delivering local anesthetic to the orbit that would serve as a valuable tool for clinicians unfamiliar or uncomfortable with performing a retrobulbar block. The depot of local anesthetic in the orbit prevents the transmission and transduction of nociceptive input to the CNS. This, with opioid administration (and ideally an NSAID unless contraindicated), provides multimodal analgesia, allowing for the doses of the individual drugs to be reduced, decreasing the potential for any dose-dependent adverse effects while providing more effective analgesia than any one drug alone.—Martin Kennedy, DVM

Source

Use of lidocaine-bupivacaine-infused absorbable gelatin hemostatic sponges versus lidocaine-bupivacaine retrobulbar injections for postoperative analgesia following eye enucleation in dogs. Ploog CL, Swinger RL, Spade J, et al. JAVMA 244:57-62, 2013.

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