Strabismus surgery under augmented topical anesthesia

Purpose: Recently, topical lidocaine 2\% jelly had been used in phacoemulsification and trabeculectomy surgeries. The purpose of this study is to evaluate the efficacy and stability of one-stage adjustable suture using topical lidocaine jelly 2\% in combination with intravenous nalbuphine (Nubain). Methods: Forty adult patients aged 16 to 46 years (median, 24 years) underwent adjustable rectus muscle surgery under topical lidocaine jelly 2\% and intravenous 10 mg nalbuphine given 10 minutes before surgery. Adjustment was performed on the operating table before conjunctival closure. The stability of adjustment was studied by comparing the postadjustment deviation to that at 1 day, 1 week, and 3 weeks postoperatively. Success was defined as alignment within 10 prism diopters on distant fixation. Analgesia was assessed using Verbal Description Scale. Changes in vital signs were recorded during surgery to evaluate the oculocardiac reflex. Results: Forty rectus muscles were recessed, 22 muscles were resected, 3 muscles were tucked, and 2 muscles were retrieved. During the operation, 35 patients expressed no pain, 3 patients complained of discomfort, and 2 patients complained of distressing pain and required an additional 10 mg of intravenous nalbuphine. Thirty-eight patients (95\%) were successfully aligned during the first postoperative day, 37 patients (92.5\%) after 1 week, and 36 patients (90\%) after 3 weeks. Intraoperative cardiac monitoring did not record positive oculocardiac reflex in any patient. Conclusion: Lidocaine jelly in combination with intravenous nalbuphine is an effective topical anesthesia strategy that provides for the patient's comfort and the surgeon's ability to fine-tune ocular alignment on the operating table.