Ophthalmology
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Randomized Controlled Trial Comparative Study Clinical Trial
Ketorolac versus acetaminophen or ibuprofen in controlling postoperative pain in patients with strabismus.
Ketorolac is a new, parenteral, nonsteroidal, anti-inflammatory agent. The authors compare the effectiveness of a single intravenous dose of ketorolac with a single oral dose of either acetaminophen or ibuprofen in controlling postoperative pain in patients with strabismus. ⋯ Intravenous ketorolac given at the conclusion of surgery was more effective than either oral acetaminophen or oral ibuprofen given 30 to 45 minutes after strabismus surgery in controlling postoperative pain. Pain relief was achieved earlier by intravenous delivery than by oral agents. Greater pain relief with ketorolac was sustained 5 hours after surgery. This facilitates suture adjustment and earlier discharge. Similar pain control is possible for other ophthalmologic surgery. Because the oral medications used in this study were administered in capsules, the results may have been different if clinically available preparations had been tested.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective study of sub-Tenon's versus retrobulbar anesthesia for inpatient and day-surgery trabeculectomy.
Several retrospective studies have demonstrated the safety and efficacy of sub-Tenon's anesthesia in ocular surgery. This is the first prospective randomized study comparing sub-Tenon's versus retrobulbar anesthesia for glaucoma surgery. ⋯ Sub-Tenon's anesthesia is safe and effective for patients undergoing either inpatient or day-surgery trabeculectomies, and it requires less local anesthetic than retrobulbar anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Peribulbar anesthesia. Effect of bicarbonate on mixtures of lidocaine, bupivacaine, and hyaluronidase with or without epinephrine.
The pH-adjustment of local anesthetic solutions with sodium bicarbonate may shorten onset time and improve spread of neural blockade. The authors undertook a prospective, double-masked, randomized study to see if a pH-adjusted mixture of lidocaine, bupivacaine, and hyaluronidase had faster and more complete onset of neural blockade, when used for peribulbar anesthesia. Eighty patients were randomly assigned to four groups and received a peribulbar block with one of four mixtures: group 1 (L) = 2% lidocaine, group 2 (LPH) = 2% lidocaine with 0.06 meq/ml sodium bicarbonate, group 3 (LE) = 2% lidocaine with 1:100,000 epinephrine (commercially prepared), or group 4 (LEPH) = 2% lidocaine with 1:100,000 epinephrine with 0.06 meq/ml sodium bicarbonate. ⋯ The LPH group had the fastest onset to complete akinesia (7.0 +/- 2.0 minutes, mean +/- SEM) when compared with the onset time of all other groups (group 1 = 11.5 +/- 1.9 minutes, group 4 = 13.1 +/- 1.4 minutes, and group 3 = 16.0 +/- 1.8 minutes, significance greater than 95% by analysis of variance). Furthermore, when compared with group 3 by analysis of variance, group 4 had a faster onset time. The authors conclude that pH-adjustment of solutions with bicarbonate of either lidocaine/bupivacaine/hyaluronidase or commercially prepared lidocaine with epinephrine/bupivacaine/hyaluronidase decreases the onset time of peribulbar anesthesia.
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Randomized Controlled Trial Clinical Trial
Bicarbonate-buffered lidocaine-epinephrine-hyaluronidase for eyelid anesthesia.
A double-masked, randomized clinical trial was conducted to determine if subcutaneous eyelid injections of a bicarbonate-buffered lidocaine-epinephrine-hyaluronidase mixture were less painful than unbuffered injections. Twenty-one patients received both buffered (pH = 7.4) and unbuffered (pH = 4.6) injections. ⋯ Seventeen (81%) of 21 patients ranked the buffered injection less painful. Use of a bicarbonate-buffered lidocaine-epinephrine-hyaluronidase mixture is effective in making ophthalmic anesthesia less painful.
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Randomized Controlled Trial Comparative Study Clinical Trial
Outpatient topical use of povidone-iodine in preparing the eye for surgery.
Povidone-iodine 5% solution placed on the eye immediately before ophthalmic surgery within the preoperative preparation significantly reduces the conjunctival bacterial flora. In 40 patients undergoing ophthalmic surgery, the authors compared the outpatient use of povidone-iodine for 3 days before surgery with a 3-day course of a combination antibiotic ophthalmic solution (Neosporin) placed on the other eye. ⋯ Cultures taken after preparation but before commencement of surgery showed a further reduction for both regimens, but more for eyes previously treated with the antibiotic (P less than 0.02). To minimize the conjunctival bacterial flora before surgery, the authors continue to recommend instillation of a broad-spectrum antibiotic for 3 days before surgery, followed by application of povidone-iodine solution to the eye immediately before surgery within the preoperative preparation.