Formulation of a Peribulbar Block for Prolonged Postoperative Pain Management in Vitreoretinal Surgery: A Randomized Clinical Trial

Sonia Mehta, Philip Laird, Matthew Debiec, Cindy Hwang, Rui Zhang, Jiong Yan, Andrew Hendrick, G. Baker Hubbard, Chris S. Bergstrom, Steven Yeh, Alcides Fernandes, Timothy Olsen

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery. Design: Prospective, parallel-assigned, single-masked, randomized clinical trial. Participants: Fifty-eight patients undergoing scleral buckle, vitrectomy, or combined surgery. Methods: In a single academic institutional practice, 58 patients undergoing scleral buckle, vitrectomy, or combined surgery were enrolled. Exclusion criteria included those with a risk for glaucoma, a pre-existing chronic pain disorder, among others. Patients were assigned randomly to receive a postoperative peribulbar formulation of either bupivacaine, triamcinolone acetonide, and cefazolin (group A) or bupivacaine, balanced salt solution, and cefazolin (group B). The postoperative pain score and ocular motility were assessed by a masked observer on the first postoperative day. Main Outcome Measures: The primary outcome measure was the postoperative pain score. Secondary outcome measures included oral analgesic use, ocular motility, and intraocular pressure (IOP). Results: The mean pain scores were 2.8±2.9 for group A and 3.8±2.6 for group B (P = 0.095). Pain was absent in 28% of group A patients versus 14% of group B patients (P = 0.11). Group A required less narcotic pain medication (hydroxycodone: group A, 0.7±3 mg vs. group B, 3±6 mg; P = 0.05; oxycodone: group A, 7±7 mg vs. 9±13 mg; P = 0.2) than group B. Motility was full in group B and limited in group A (P ≤ 0.001), with no differences in mean IOP measurements at any point after surgery. Conclusions: We did not demonstrate a statistically significant reduction in mean postoperative pain scores. However, patients in group A required less hydroxycodone use and had greater akinesia, suggesting prolonged neural blockade.

Original languageEnglish (US)
Pages (from-to)268-275
Number of pages8
JournalOphthalmology Retina
Volume2
Issue number4
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

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Vitreoretinal Surgery
Pain Management
Postoperative Pain
Randomized Controlled Trials
Cefazolin
Bupivacaine
Vitrectomy
Outcome Assessment (Health Care)
Intraocular Pressure
Pain
Institutional Practice
Oxycodone
Triamcinolone Acetonide
Somatoform Disorders
Narcotics
Chronic Pain
Glaucoma
Analgesics
Salts
Injections

ASJC Scopus subject areas

  • Ophthalmology

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Formulation of a Peribulbar Block for Prolonged Postoperative Pain Management in Vitreoretinal Surgery : A Randomized Clinical Trial. / Mehta, Sonia; Laird, Philip; Debiec, Matthew; Hwang, Cindy; Zhang, Rui; Yan, Jiong; Hendrick, Andrew; Hubbard, G. Baker; Bergstrom, Chris S.; Yeh, Steven; Fernandes, Alcides; Olsen, Timothy.

In: Ophthalmology Retina, Vol. 2, No. 4, 01.04.2018, p. 268-275.

Research output: Contribution to journalArticle

Mehta, S, Laird, P, Debiec, M, Hwang, C, Zhang, R, Yan, J, Hendrick, A, Hubbard, GB, Bergstrom, CS, Yeh, S, Fernandes, A & Olsen, T 2018, 'Formulation of a Peribulbar Block for Prolonged Postoperative Pain Management in Vitreoretinal Surgery: A Randomized Clinical Trial', Ophthalmology Retina, vol. 2, no. 4, pp. 268-275. https://doi.org/10.1016/j.oret.2017.07.011
Mehta, Sonia ; Laird, Philip ; Debiec, Matthew ; Hwang, Cindy ; Zhang, Rui ; Yan, Jiong ; Hendrick, Andrew ; Hubbard, G. Baker ; Bergstrom, Chris S. ; Yeh, Steven ; Fernandes, Alcides ; Olsen, Timothy. / Formulation of a Peribulbar Block for Prolonged Postoperative Pain Management in Vitreoretinal Surgery : A Randomized Clinical Trial. In: Ophthalmology Retina. 2018 ; Vol. 2, No. 4. pp. 268-275.
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abstract = "Purpose: To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery. Design: Prospective, parallel-assigned, single-masked, randomized clinical trial. Participants: Fifty-eight patients undergoing scleral buckle, vitrectomy, or combined surgery. Methods: In a single academic institutional practice, 58 patients undergoing scleral buckle, vitrectomy, or combined surgery were enrolled. Exclusion criteria included those with a risk for glaucoma, a pre-existing chronic pain disorder, among others. Patients were assigned randomly to receive a postoperative peribulbar formulation of either bupivacaine, triamcinolone acetonide, and cefazolin (group A) or bupivacaine, balanced salt solution, and cefazolin (group B). The postoperative pain score and ocular motility were assessed by a masked observer on the first postoperative day. Main Outcome Measures: The primary outcome measure was the postoperative pain score. Secondary outcome measures included oral analgesic use, ocular motility, and intraocular pressure (IOP). Results: The mean pain scores were 2.8±2.9 for group A and 3.8±2.6 for group B (P = 0.095). Pain was absent in 28{\%} of group A patients versus 14{\%} of group B patients (P = 0.11). Group A required less narcotic pain medication (hydroxycodone: group A, 0.7±3 mg vs. group B, 3±6 mg; P = 0.05; oxycodone: group A, 7±7 mg vs. 9±13 mg; P = 0.2) than group B. Motility was full in group B and limited in group A (P ≤ 0.001), with no differences in mean IOP measurements at any point after surgery. Conclusions: We did not demonstrate a statistically significant reduction in mean postoperative pain scores. However, patients in group A required less hydroxycodone use and had greater akinesia, suggesting prolonged neural blockade.",
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T2 - A Randomized Clinical Trial

AU - Mehta, Sonia

AU - Laird, Philip

AU - Debiec, Matthew

AU - Hwang, Cindy

AU - Zhang, Rui

AU - Yan, Jiong

AU - Hendrick, Andrew

AU - Hubbard, G. Baker

AU - Bergstrom, Chris S.

AU - Yeh, Steven

AU - Fernandes, Alcides

AU - Olsen, Timothy

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N2 - Purpose: To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery. Design: Prospective, parallel-assigned, single-masked, randomized clinical trial. Participants: Fifty-eight patients undergoing scleral buckle, vitrectomy, or combined surgery. Methods: In a single academic institutional practice, 58 patients undergoing scleral buckle, vitrectomy, or combined surgery were enrolled. Exclusion criteria included those with a risk for glaucoma, a pre-existing chronic pain disorder, among others. Patients were assigned randomly to receive a postoperative peribulbar formulation of either bupivacaine, triamcinolone acetonide, and cefazolin (group A) or bupivacaine, balanced salt solution, and cefazolin (group B). The postoperative pain score and ocular motility were assessed by a masked observer on the first postoperative day. Main Outcome Measures: The primary outcome measure was the postoperative pain score. Secondary outcome measures included oral analgesic use, ocular motility, and intraocular pressure (IOP). Results: The mean pain scores were 2.8±2.9 for group A and 3.8±2.6 for group B (P = 0.095). Pain was absent in 28% of group A patients versus 14% of group B patients (P = 0.11). Group A required less narcotic pain medication (hydroxycodone: group A, 0.7±3 mg vs. group B, 3±6 mg; P = 0.05; oxycodone: group A, 7±7 mg vs. 9±13 mg; P = 0.2) than group B. Motility was full in group B and limited in group A (P ≤ 0.001), with no differences in mean IOP measurements at any point after surgery. Conclusions: We did not demonstrate a statistically significant reduction in mean postoperative pain scores. However, patients in group A required less hydroxycodone use and had greater akinesia, suggesting prolonged neural blockade.

AB - Purpose: To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery. Design: Prospective, parallel-assigned, single-masked, randomized clinical trial. Participants: Fifty-eight patients undergoing scleral buckle, vitrectomy, or combined surgery. Methods: In a single academic institutional practice, 58 patients undergoing scleral buckle, vitrectomy, or combined surgery were enrolled. Exclusion criteria included those with a risk for glaucoma, a pre-existing chronic pain disorder, among others. Patients were assigned randomly to receive a postoperative peribulbar formulation of either bupivacaine, triamcinolone acetonide, and cefazolin (group A) or bupivacaine, balanced salt solution, and cefazolin (group B). The postoperative pain score and ocular motility were assessed by a masked observer on the first postoperative day. Main Outcome Measures: The primary outcome measure was the postoperative pain score. Secondary outcome measures included oral analgesic use, ocular motility, and intraocular pressure (IOP). Results: The mean pain scores were 2.8±2.9 for group A and 3.8±2.6 for group B (P = 0.095). Pain was absent in 28% of group A patients versus 14% of group B patients (P = 0.11). Group A required less narcotic pain medication (hydroxycodone: group A, 0.7±3 mg vs. group B, 3±6 mg; P = 0.05; oxycodone: group A, 7±7 mg vs. 9±13 mg; P = 0.2) than group B. Motility was full in group B and limited in group A (P ≤ 0.001), with no differences in mean IOP measurements at any point after surgery. Conclusions: We did not demonstrate a statistically significant reduction in mean postoperative pain scores. However, patients in group A required less hydroxycodone use and had greater akinesia, suggesting prolonged neural blockade.

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