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Abstract

Background & objective: Peribulbar block is used to prevent oculocardiac reflex (OCR) in children in addition to general anesthesia (GA). We compared GA with a single peribulbar block using articaine 4%, lidocaine 2%, or mepivacaine 3% for the prevention of the oculocardiac reflex (OCR) in children undergoing strabismus surgery.
Methodology: Fifty-five patients (7-14 years, both sexes) scheduled for strabismus surgery were enrolled in this randomized clinical trial. The sample size was calculated using Epi-info software, based on the following considerations: power at 80%, confidence limit at 10%, and alpha error at 5%. All received GA and a peribulbar block, divided as follows: Group A (n = 19): 5 mL articaine 4% with 1:100,000 adrenaline and 10 IU hyaluronidase; Group L (n = 18): 5 mL lidocaine 2% with 10 IU hyaluronidase; and Group M (n = 18): 5 mL mepivacaine 3% with 10 IU hyaluronidase. Continuous intraoperative monitoring (electrocardiography, pulse oximetry, capnography) was done, and Ringer's lactate was used for adequate hydration. Postoperative nausea and vomiting (PONV) were prevented with intravenous granisetron (0.01 mg/kg). The primary outcome of the study was the prevention of the OCR. The secondary outcomes were postoperative pain, PONV, Aldrete scores, and surgeon satisfaction.
Results: The Articaine group had the lowest occurrence of NSAID use, postoperative nausea and vomiting, subconjunctival hemorrhage, atropine use, as well as the surgeon stop request. In addition, the lidocaine group had the lowest number of positive VAS. Moreover, OCR episodes were the lowest among Group A. Only a single episode occurred in a single person. This is compared to 4 and 3 patients affected in the Groups L and M, respectively. On the other hand, Group A reported the highest number of shifted eyes (3) in comparison with 2 and 1 in Groups L and M, respectively. For ballooning, Group L had the lowest occurrence with a single event compared with 2 events in the other two groups, without a substantial difference (P > 0.05).
Conclusions: Articaine 4% was the most effective in reducing the incidence of the OCR and improving both intraoperative and postoperative outcomes in pediatric strabismus surgery.
Abbreviations: HA: hyaluronic acid. LA: Local anesthetics, OCR: oculocardiac reflex
Keywords: Articaine; Lidocaine; Mepivacaine; Oculocardiac Reflex; Strabismus Surgery
Citation: Salem AS, Mansour AZ, Eldeen HB, Nasralla HAE, Farag A. Comparing a single injection peribulbar block with articaine 4% vs lidocaine 2% vs mepivacaine 3% for prevention of oculocardiac reflex in children undergoing strabismus surgery under general anesthesia: a randomized clinical trial. Anaesth. pain intensive care 2025;29(6):535-540. DOI: 10.35975/apic.v29i6.2905
Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025