The effect of paracetamol on postoperative nausea and vomiting during the first 24 h after strabismus surgery: a prospective, randomised, double-blind study.

CONTEXT: Strabismus surgery is one of the most common ophthalmic surgical procedures in children and is associated with significant postoperative nausea and vomiting (PONV). OBJECTIVE: We evaluated the effect of intravenous paracetamol on PONV in children after strabismus surgery. DESIGN: Prospective, placebo-controlled, randomised double-blind study. SETTING: University hospital. PATIENTS: Ninety children, between 2 and 14 years scheduled for strabismus surgery, were recruited. Eighty-six completed the study. INTERVENTIONS: After induction of anaesthesia, intravenous dexamethasone 0.1 mg kg was administered to all. The patients were enrolled to receive either intravenous physiological saline (group S) or paracetamol 15 mg kg (group P). MAIN OUTCOME MEASURE: Incidence of PONV in the first 24 h postoperatively. RESULTS: General and clinical characteristics of the children were similar in both groups. PONV during the first 24 h was significantly higher in group S in comparison with group P (group S vs. group P, 33 vs. 14.6%, respectively, P = 0.038 for nausea; 24.4 vs. 7.3%, respectively, P = 0.030 for vomiting). The number of analgesic administrations during the first 24 h was higher in group S compared with group P (1.31 ±â€Š0.85 and 0.73 ±â€Š0.6, respectively, P = 0.001). The repeat number of postoperative analgesic administrations was significantly different between groups during the first 24 h (P = 0.005), but during 24-48 h was not significant. CONCLUSION: Intraoperative administration of intravenous paracetamol decreases the incidence of PONV during the first 24 h in children after strabismus surgery.

Pain management in blind, painful eyes: clinical experience with retrobulbar alcohol injection in 4 cases.

Ocular pain is often difficult to treat and may be caused by many eye diseases. The first step in pain management is medical therapy combined with analgesics; however, severe and resistant cases may require neurolytic eye blocks or definitive surgery. Retrobulbar block with neurolytic agents such as alcohol may be preferred, if the eye is cosmetically normal or the patient is medically or psychologically unsuitable for enucleation or evisceration. Here, we present our successful and efficient pain management using retrobulbar alcohol injection in 4 patients with painful blind eyes. Patients with neovascular glaucoma presenting with painful blind eyes were accepted to our clinic for pain management. The patients had continuous pain with an increasing severity in the recent months. We planned to perform retrobulbar alcohol injection as the pain of the patients was resistant to medical therapy. We noted measurement of verbal analogue scale for pain (VAS) before the block (7, 9, 9 and 10, respectively), after retrobulbar lidocaine and alcohol injection, at the postoperative 1st day, 1st, 2nd 3rd and 4th weeks, and 3rd, 4th, 5th, 6th and 12th months. Early and late complications were also recorded. On the first day after injection, no patient required additive analgesic therapy and their VAS scores were 0, 0, 0, and 3, respectively. Except for one patient who underwent enucleation because of a bacterial infection, the other three patients' VAS scores were 1, 0 and 1 at the 12th month assessment. We suggest that neurolytic retrobulbar block is an efficient pain management strategy in blind painful eyes.

Limbal stem cell transplantation with amniotic membrane for the treatment of uniocular chemical burn in children.

This study evaluated the outcome of corneal surface reconstruction with conjunctival limbal autograft and amniotic membrane transplantation in two children with unilateral ocular chemical burn who underwent surgery. Visual acuity improved from counting fingers at face to 20/60 in one patient and from counting fingers at 30 cm to 20/100 in the other. Both patients received simultaneous symblepharon lysis and regained deep fornices. When used in combination with amniotic membrane, conjunctival autograft allows correction of cicatricial abnormalities and early restoration of corneal surface integrity. Intervention within 6 months is desirable for rehabilitation of vision in the amblyogenic period.

Rhombencephalosynapsis associated with infantile strabismus.

INTRODUCTION: Malformations of the cerebellum have been well-known to coexist with abnormalities of the oculomotor system. Rhombencephalosynapsis (RES) is a rare malformation of the cerebellum of unknown etiology in which the vermis is hypoplastic and the two cerebellar hemispheres are fused. The type of oculomotor disorders associated with RES is not well documented in the literature. Here, two cases are presented. CASE 1: A 15-year-old girl presented with large-angle infantile esotropia and inferior oblique overaction. Slow (3 to 4 cps) rhythmic anteroposterior oscillation movement of the head was observed while walking and left-sided postural tremor was present. CASE 2: An 8-month-old baby girl presented with facial dysmorphism, right esotropia, anisometropia, motor delay and truncal ataxia. Cranial MRI demonstrated RES in both patients. CONCLUSION: The clinical findings in two children presenting with infantile esotropia and RES may suggest a role of the vermis in ocular alignment. Head nodding in a child with strabismus can be observed only when walking and its presence should prompt neuroimaging.