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Effects of an infratrochlear nerve block on reducing the oculocardiac reflex during strabismus surgery: a randomized controlled trial

  • Seung-Hyun Kim
  • Hyun Jin ShinEmail author
Pediatrics
  • 241 Downloads

Abstract

Purpose

To determine whether an infratrochlear nerve block (ITB) can reduce the oculocardiac reflex (OCR) during strabismus surgery on the medial rectus muscle (MR).

Methods

This prospective, randomized single-masked study included 60 patients with intermittent exotropia scheduled for unilateral MR resection/lateral rectus recession under general anesthesia. Patients were randomly allocated to receive a regional nerve block of the infratrochlear nerve (ITB group) prior to surgery or standard treatment without a nerve block (control group). The OCR was defined as a sudden decrease in heart rate of ≥ 15% from baseline. Changes in heart rate (HR) and the incidence of the OCR were measured during the three stages of surgery applied to the MR in each group: conjunctival incision, muscle dissection, and muscle traction.

Results

There were no intergroup differences in patient demographics or baseline HR. The mean HRs during conjunctival incision, muscle dissection, and muscle traction were 94, 90, and 96 bpm, respectively, in the ITB group, and 85, 68, and 84 bpm in the control group; the corresponding OCR incidence rates were 3, 20, and 10%; and 7, 87, and 38%. The HR was higher and the OCR incidence was lower in the ITB group than in the control group during muscle dissection and traction (all p < 0.05).

Conclusions

An ITB maintains a stable HR and reduces the OCR during surgery on the MR. The ITB is less invasive and easily accessible to a surgeon, and can help improve the safety of strabismus surgery.

Keywords

Infratrochlear nerve block Medial rectus Oculocardiac reflex Strabismus surgery 

Notes

Author contributions

SH Kim designed the study and revised the manuscript, and HJ Shin collected and analyzed the data and wrote the manuscript.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2016R1C1B1014199). This support had no role in the design or conduct of this study.

Compliance with ethical standards

This clinical study was approved by the Institutional Review Board/Ethics Committee at Konkuk University Medical Center (registration number KUH1100040) and registered with the Clinical Research Information Service, Republic of Korea (https://cris.nih.go.kr/cris/index.jsp; registration number KCT0002378). The study was conducted according to the principles expressed in the Declaration of Helsinki with written informed patient and parental consents.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All patients confirmed as American Society of Anesthesiologists physical status classification I. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name the institution/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

417_2018_4001_MOESM1_ESM.doc (70 kb)
ESM 1 (DOC 69 kb)

References

  1. 1.
    Coats DK, Olitsky SE (2007) Strabismus surgery and its complication. New York, Springer, pp 52–55Google Scholar
  2. 2.
    Apt L, Isenberg S, Gaffney WL (1973) The oculocardiac reflex in strabismus surgery. Am J Ophthalmol 76:533–536CrossRefPubMedGoogle Scholar
  3. 3.
    Lai YH, Hsu HT, Wang HZ, Cheng KI, Wu KY (2014) The oculocardiac reflex during strabismus surgery: its relationship to preoperative clinical eye findings and subsequent postoperative emesis. J AAPOS 18:151–155CrossRefPubMedGoogle Scholar
  4. 4.
    Aletaha M, Bagheri A, Roodneshin F, Mosallaei M, Yazdani S (2016) Oculocardiac reflex during strabismus surgery experience from a tertiary hospital. Strabismus 24:74–78CrossRefPubMedGoogle Scholar
  5. 5.
    Loewinger J, Friedmann-Nieger I, Cohen M, Levi E (1991) Effects of atracurium and pancuronium on the oculocardiac reflex in children. Anesth Analg 73:25–28CrossRefPubMedGoogle Scholar
  6. 6.
    Nihalani BR, Hunter DG (2011) Adjustable suture strabismus surgery. Eye 25:1262–1276CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Arnold RW, Ellis FD, Wolfe TM (1997) Prolonged oculocardiac reflex during strabismus surgery under topical anesthesia. J Pediatr Ophthalmol Strabismus 34:252–254PubMedGoogle Scholar
  8. 8.
    Lübbers HT, Zweifel D, Grätz KW, Kruse A (2010) Classification of potential risk factors for trigeminocardiac reflex in craniomaxillofacial surgery. J Oral Maxillofac Surg 68:1317–1321CrossRefPubMedGoogle Scholar
  9. 9.
    Sorenson EJ, Gilmore JE (1956) Cardiac arrest during strabismus surgery. Am J Ophthalmol 41:748–752CrossRefPubMedGoogle Scholar
  10. 10.
    Alexander J (1975) Reflex disturbances of cardiac rhythm during ophthalmic surgery. Br J Ophthalmol 59:518–524CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Fayon M, Gauthier M, Blanc VF, Ahronheim GA, Michaud J (1995) Intraoperative cardiac arrest due to the oculocardiac reflex and subsequent death in a child with occult Epstein-Barr virus myocarditis. Anesth 83:622–624CrossRefGoogle Scholar
  12. 12.
    Welhalf WR, Johnson DC (1965) The oculocardiac reflex during extraocular muscle surgery. Arch Ophthalmol 73:43–45CrossRefGoogle Scholar
  13. 14.
    Dutton JJ (2011) Atlas of clinical and surgical orbital anatomy. Elsevier, Amsterdam, pp 58–60Google Scholar
  14. 15.
    HK Y, Hwang JM (2009) Bilateral vs unilateral medial rectus resection for recurrent exotropia after bilateral lateral rectus recession. Am J Ophthalmol 148:459–465CrossRefGoogle Scholar
  15. 16.
    Kim H, Yang HK, Hwang JM (2016) Comparison of long-term surgical outcomes between unilateral recession and unilateral recession-resection in small-angle exotropia. Am J Ophthalmol 166:141–148CrossRefPubMedGoogle Scholar
  16. 17.
    García-Moreno H, Cuadrado ML (2016) Infratrochlear nerve block for a new infratrochlear neuralgia. Cephalalgia 36:395–396CrossRefPubMedGoogle Scholar
  17. 18.
    Digre KB, Brennan KC (2012) Shedding light on photophobia. J Neuroophthalmol 32:68–81CrossRefPubMedPubMedCentralGoogle Scholar
  18. 19.
    Costa PG, Debert I, Passos LB, Polati M (2006) Persistent diplopia and strabismus after cataract surgery under local anesthesia. Binocul Vis Strabismus Q 21:155–158PubMedGoogle Scholar
  19. 20.
    Blum RA, Lim LT, Weir CR (2012) Diplopia following sub-tenon’s anaesthesia. Int Ophthalmol 32:191–193CrossRefPubMedGoogle Scholar
  20. 21.
    Joo J, Lee S, Lee Y (2014) Emergence delirium is related to the invasiveness of strabismus surgery in preschool-age children. J Int Med Res 42:1311–1322CrossRefPubMedGoogle Scholar
  21. 22.
    Rodgers A, Cox RG (2010) Anesthetic management for pediatric strabismus surgery: continuing professional development. Can J Anaesth 57:602–617CrossRefPubMedGoogle Scholar
  22. 23.
    Karaman T, Demir S, Dogru S, Şahin A, Tapar H, Karaman S, Kaya Z, Suren M, Arici S (2016) The effect of anesthesia depth on the oculocardiac reflex in strabismus surgery. J Clin Monit Comput 30:889–893CrossRefPubMedGoogle Scholar
  23. 24.
    Defalque RJ (1969) Retrobulbar block for oculocardiac reflex: duration of protection by common local anesthetics. Acta Ophthalmol 47:998–1003CrossRefGoogle Scholar
  24. 25.
    Grover VK, Bhardwaj N, Shobana N, Grewal SP (1998) Oculocardiac reflex during retinal surgery using peribulbar block and nitrous narcotic anesthesia. Ophthalmic Surg Lasers 29:207–212PubMedGoogle Scholar
  25. 26.
    Zhang C, Phamonvaechavan P, Rajan A, Poon DY, Topcu-Yilmaz P, Guyton DL (2010) Concentration-dependent bupivacaine myotoxicity in rabbit extraocular muscle. J AAPOS 14:323–327CrossRefPubMedGoogle Scholar
  26. 27.
    Karhunen U, Nilsson E, Brander P (1985) Comparison of four non-depolarizing neuromuscular blocking drugs in the suppression of the oculocardiac reflex during strabismus surgery in children. Br J Anaesth 57:1209–1212CrossRefPubMedGoogle Scholar
  27. 28.
    Ruta U, Möllhoff T, Markodimitrakis H, Brodner G (1996) Attenuation of the oculocardiac reflex after topically applied lignocaine during surgery for strabismus in children. Eur J Anaesthesiol 13:11–15CrossRefPubMedGoogle Scholar
  28. 29.
    Hertle RW, Granet DB, Zylan S (1993) The intraoperative oculocardiac reflex as a predictor of postoperative vaso-vagal responses during adjustable suture surgery. J Pediatr Ophthalmol Strabismus 30:306–311PubMedGoogle Scholar
  29. 30.
    Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH (2008) Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiol Scand 52:1273–1277CrossRefPubMedGoogle Scholar
  30. 31.
    Dach F, Éckeli ÁL, Ferreira Kdos S, Speciali JG (2015) Nerve block for the treatment of headaches and cranial neuralgias—a practical approach. Headache 55(Suppl 1):59–71CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology Korea University Medical CenterKorea University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Ophthalmology, Konkuk University Medical CenterKonkuk University School of MedicineSeoulRepublic of Korea

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