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Comparison of Retrobulbar Analgesics for Evisceration

Purpose To determine whether postoperative pain and nausea after evisceration surgery is better controlled with intraoperative retrobulbar ethanol or bupivacaine. Methods Prospective, randomized, clinical trial. Eleven patients undergoing evisceration surgery by two surgeons over a 6-month period for blind, chronically painful eyes were randomly allocated in two groups. One group (5 patients) received prophylactic retrobulbar 95% ethanol injections; the control group (6 patients) received retrobulbar 0.75% bupivacaine with 1:100,000 epinephrine. Postoperative pain and nausea were recorded by the patients with the use of a 10-point analog scale. Patients also documented the quantity of analgesics required. Results The mean and median postoperative pain and nausea scores were significantly lower for patients given intraoperative retrobulbar ethanol (paired t test, P <0.01). These patients also required significantly less analgesic medicine. Complications from the retrobulbar ethanol injections included forehead numbness and ptosis, both of which had resolved by the time of prosthesis fitting 6 weeks later. Conclusions Surgeons should consider the use of intraoperative retrobulbar ethanol injections to help relieve postoperative pain and nausea.