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This is a study based on existing evidence that pre-emptive pain control has advantages over traditional post-surgical analgesia. The authors compared pain scores in three groups of randomly assigned and masked patients all undergoing orbital implant surgery under general anaesthesia using propofol and remifentanyl. All three had a preoperative 3ml retrobulbar injection of 1% lidocaine mixed with 0.5% ropivacaine. In addition to this, group F had flurbiprofen axetil (a non-steroidal anti-inflammatory) 1mg / kg IV, group N had nalbuphine (a synthetic opioid) 0.1mg / kg IV, and group C had normal saline IV. Pain scores on a 0-10 scale were recorded preoperatively, and two, four, six, 12 and 24 hours postoperatively. A quality of recovery questionnaire was also completed preoperatively and at 24 hours after surgery. There were 15 patients in each group. Patients in group F had significantly lower pain scores at two and four hours postoperatively compared with the control group C. Patients in group N had significantly lower scores at two hours compared with group C. There were no other differences at other time points, and no differences in adverse effects from the analgesics, in paracetamol consumption or in the quality of recovery questionnaire scores. The authors recommend multimodal analgesia which potentially offers better pain control and less dependence on opiates. They argue that use of an anti-inflammatory agent may have a particular role in orbital surgery where pain may be partly attributed to raised intra-orbital pressure. Although the non-steroidal was superior in the immediate postoperative four hours, there were no differences beyond this time, and no assessment of pain over a more prolonged time course.

Effect of multimodal preemptive analgesia of flurbiprofen axetil, nalbuphine, and retrobulbar block on postoperative pain and enhanced recovery in patients undergoing oculoplastic day surgery: a prospective, randomized, double-blinded study.
Ye Z, Zhu Y, Zhang R, et al.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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