Ultrasound navigation during blockade in children with retinoblastoma with enucleation of the eyeball

Abstract

   Introduction. Regional blockades in children in ophthalmology operations are used not only for analgesia in the intra- and postoperative period, but also for the prevention of oculocardial reflex (OCR), postoperative nausea and vomiting (PONV). But there is still no convincing data on the advantages of the methods of retrobulbar blockade (RBB) performed under ultrasound guidance and parabulbar blockade (PBB) performed under ultrasound guidance.   Aim. In the present study, we investigated the efficacy and safety of RBB under ultrasound guidance with ropivacaine 0.5 % for the prevention of OCR and postoperative pain, as well as PONV when detected with PBB of ropivacaine 0.5 % under ultrasound guidance upon detection of enucleation of the eyeball.   Materials and methods. A prospective randomized arterial study was performed for the period 2016–2022. The study included 110 patients with established inclusion criteria. The patients were divided into two groups: 55 patients who performed a RBB + ultrasound and 55 patients who performed a PBB + ultrasound. Evaluated: the likelihood of the introduction of opioid analgesics, the quality of anesthesia, the duration of the block and the likelihood of complications.   Results. There was a decrease in intraoperative diseases in the RBB + ultrasound group, where the average dose of fentanyl was increased by 4.1 ± 1.4 μg/kg, and in the PBB + ultrasound group it was 9.7 ± 1.8 μg/kg (p < 0.05 ). The time to the first frequency of the analgesic in the postoperative period was 6.7 ± 1.8 hours in the PBB + ultrasound group, and 11.7 ± 3.3 hours in the RBB + ultrasound group (p < 0.05).   Conclusions. There was a significant difference in analgesic efficacy between RBB + ultrasound and PBB + ultrasound. It was revealed that RBB + ultrasound reduces intraoperative opioid requirements, stable intraoperative hemodynamics and longer postoperative analgesia. Therefore, the use of RBB + ultrasound for enucleation of the eyeball in children with retinoblastoma is the preferred technique.