[Postoperative pain in retinal detachment surgery]. / Douleur postopératoire dans la chirurgie de décollement de rétine.

Postoperative pain in retinal detachment surgery is frequent but it is often underestimated. The aim of this study was to determine the incidence of postoperative pain after retinal detachment surgery and to identify its predictive factors in a longitudinal study. We included 106 patients operated for retinal detachment surgery using an endo-ocular or exo-ocular approach with general anesthesia. Postoperative monitoring for 24 h evaluated the intensity of pain using a numerical scale. The possible predictive factors of this pain were studied: ocular antecedents, premedication, total amount of morphine used, type of surgery, duration of surgery, and vomiting. The incidence of postoperative pain was 57.5%, 56% of which was intense pain. Postoperative pain was greatest during the first 4 h. The predictive factors of this pain revealed by bivariate analysis of the data were the type of surgery and vomiting. The incidence and intensity of postoperative pain after retinal detachment surgery remain high. Pain management requires postoperative treatment of vomiting as well as the development of the endo-ocular surgery and locoregional anesthesia techniques.

Lidocaine-clonidine retrobulbar block for cataract surgery in the elderly.

BACKGROUND AND OBJECTIVES: Clonidine, an alpha-2-adrenoreceptor agonist, has been shown to decrease intraocular pressure (IOP) and to have some analgesic and sedative effects when it is used in premedication for ophthalmic surgery. This study was designed to investigate the efficacy of lidocaine-clonidine retrobulbar block for cataract surgery with respect to its effect on IOP, analgesic action, and sedative effects. METHODS: Sixty elderly patients (ASA status I and II) were allocated randomly to receive in a prospective double-blind manner retrobulbar block for cataract surgery. Group I (n = 30) received 3-4 mL of 2% lidocaine with 1 mL saline, while group 2 (n = 30), received 3-4 mL of 2% lidocaine with clonidine 2 micrograms/kg. RESULTS: A large decrease in intraocular pressure from 13.5 +/- 4.6 to 7.7 +/- 3.7 mm Hg (P < .01) and a small but significant reduction of both systolic and diastolic blood pressure were observed 20 minutes alter the retrobulbar block in patients receiving clonidine, while no changes occurred in the control group. The median duration of analgesia and akinesia was greater in the lidocaine-clonidine group (241 +/- 88 minutes and 80 +/- 20 minutes, respectively) as compared with the lidocaine group (128 +/- 24 minutes and 70 +/- 20 minutes, respectively) (P < .01, P < .05). Sedation scores were greater in group 2 from the 10-minute point (P < .01). CONCLUSIONS: Addition of clonidine to lidocaine for retrobulbar block causes a decrease in intraocular pressure, a sedative effect, and an increased duration of analgesia and akinesia, with relatively stable hemodynamic parameters.

[Anaphylactic shock caused by application of fluorescein on the ocular conjunctiva]. / Choc anaphylactique par application de fluorescéine sur la conjonctive oculaire.

OBJECTIVE: Fluorescein is widely used in ophthalmology. Side effects related to fluorescein occur frequently but are usually benign (nausea, vomiting, lipothymia). Severe side effects are rare. We report a case of anaphylactic shock due to local application of fluorescein. CASE REPORT: A 70-year-old woman was treated for ocular conjunctivitis with local application of fluorescein. Cardiac arrest occurred due to anaphylactic shock. Resuscitation was successful. DISCUSSION: The gravity of certain complications related to the use of fluorescein underline the importance of adequate resuscitation material and adapted treatment.

[Does oral ondansetron reduce the incidence of nausea and vomiting after surgery for strabismus in children?]. / L'ondansétron oral réduit-il l'incidence des nausées et vomissements après chirurgie du strabisme chez l'enfant?

OBJECTIVE: To compare the efficacy of oral ondansetron with oral metoclopramide for the prevention of postoperative vomiting and nausea in children undergoing strabismus surgery. STUDY DESIGN: Prospective, randomized, double-blind trial. PATIENTS: Thirty children of physical class 1, age 9 +/- 4 years, scheduled for strabismus surgery, were randomized into two groups (ondansetron and metoclopramide). METHODS: In the ondansetron group, the children received the first oral dose of ondansetron (4 mg) 1 hour before induction of anaesthesia and the other doses 8 and 16 hours later. In the metoclopramide group, children received metoclopramide (5 mg) in the same conditions. Anaesthesia was induced with thiopentone, vecuronium and fentanyl and maintained with halothane and N2O/O2. Patients were evaluated by an independent observer for nausea and emesis in recovery room (0-2 h) and on the ward. The adverse effects of oral ondansetron and metoclopramide were assessed. RESULTS: There were non-significant differences between the two groups for incidence of nausea and vomiting (40% and 53% in ondansetron group versus 33 and 60% in metoclopramide group, respectively. CONCLUSION: Unlike intravenous ondansetron, oral ondansetron is not superior to metoclopramide for the prevention of nausea and vomiting caused by strabismus surgery in children.