Comparison of topical lignocaine gel and fentanyl for perioperative analgesia in children undergoing cataract surgery

Opioids continue to remain the primary analgesics in children undergoing ophthalmic surgery, and their use may be associated with adverse effects like vomiting and respiratory depression. Topical anesthesia avoids these adverse effects and also complications of regional blocks. We designed this study to verify whether topical anesthesia with lignocaine gel is a feasible alternative to intravenous (IV) fentanyl for pediatric cataract surgery. One hundred ASA I and II children aged 3-12 years, scheduled for cataract surgery were included in this study. After induction of anesthesia, children were randomized to Group F (fentanyl), who received 2 mcg.kg(-1) IV fentanyl for analgesia and Group G (lignocaine gel), who received 2% lignocaine gel applied over the cornea of the operative eye. Anesthesia was maintained with isoflurane and oxygen in nitrous oxide. All children received intramuscular ketorolac. Intraoperative supplementary analgesia was provided with 0.5 mcg.kg(-1) IV fentanyl to manage increases in heart rate or blood pressure of 20% above baseline. In the postoperative period, Aldrete score and objective pain score were assessed. Rescue analgesia was provided with fentanyl in the postanesthesia care unit and syrup ibuprofen in the ward. Significantly more children in group F (8/48) required intraoperative supplementary fentanyl as compared with group G (1/48) (P = 0.0291). In the PACU, 7/48 children of group G needed fentanyl as compared with 5/48 children in group F. Time to reach Aldrete 10 was significantly longer in group F (P = 0.01). Topical lignocaine gel is an effective analgesic and may be used as an adjunct to fentanyl during cataract surgery in children.