The experience with the application of multimodal anesthesia in pediatric ophthalmology for the treatment of the children presenting with retinopathy of prematurity

Purpose. The objective of the present study was the comparative evaluation of the effectiveness and adequacy of the regional anesthetic medication as a component of multimodal anesthesia applied in ophthalmological surgery for the treatment of the children presenting with retinopathy of prematurity. Materials and methods. The study included the comparative analysis of anesthetic support in 120 cases of the surgical intervention for the treatment of retinopathy of prematurity in the children at the age varying from 1 month to 1 year. The comparison involved three groups of the patients. The main group was comprised of the children treated with the non-steroidal anti-inflammatory agent paracetamol in the combination with retrobulbar (peribulbar) or infraocular anesthesia and the peripheral van Lint block (14 anesthesias). The control group 1 consisted of the children treated with the narcotic analgesic fentanyl (46 anesthesias) while the control group 2 was composed of the children (n = 60) given inhalation anesthesia with the use of oxygen, nitrous oxide, and sevorane). The principal hemodynamic characteristics including the heart rate, mean, systemic, systolic, and diastolic arterial pressure as well as electrocardiogram, concentration of inhalation anesthetics, capnometry, and the blood oxygenation level were monitored. In addition, the severity of pain and the frequency of apnoea during the postoperative period were evaluated. Results. The application of regional anesthesia with the use of a 0.2% solution of naropin in ophthalmological surgery for the treatment of retinopathy of prematurity in the children ensures strong enough anesthetic effect in the absence of the additional therapeutic interventions that might influence the hemodynamic characteristics and allows to refuse to use narcotic preparations as well as reduce the concentration of inhalation anesthetics. This method improves the course of the postoperative period by virtue of the long-standing anesthetic effect, rapid restoration of consciousness, the absence of postoperative apnoea, reduction of the postoperative starvation time, and the promotion of accelerated rehabilitation of the patients.

regional anesthesia, retrobulbar blockade, hemodynamics, retinopathy of prematurity