Pain Relief after Strabismus Surgery in Children; Ketoprofen ‘Pro Re Nata’ or Scheduled Dosing?

Abstract

Objective: Little is known about recovery, pain and analgesic requirements after discharge following pediatric day-case strabismus surgery. These data are essential in order to provide parents with appropriate instructions at discharge. Methods: In this prospective, longitudinal, open study of 115 children who underwent strabismus surgery, ketoprofen tablets were prescribed at discharge to be used either as required (Group 1, n=59), or at scheduled times at a dose of 5 mg/kg in 24 h for the first 72 hours (Group 2, n=56). Paracetamol (acetaminophen) was allowed for rescue analgesia in Group 2. Parents recorded pain, pain relief, analgesic consumption, recovery and adverse effects for the first week after discharge in a diary that was returned in a prepaid envelope. Results: The response rate was 98% (113 out of 115). After discharge 51/57 children in the Group 1 and 41/56 children in the Group 2 (p = 0.026) had pain for a median of 3 days (range 1-9). Most children had mild or moderate pain, but eight children (7%) reported severe pain. The pain relief was significantly better in those children scheduled ketoprofen tablets (p = 0.003) even though more children in Group 2 (39/56) had two muscles operated upon than in Group 1 (18/57). No serious or unexpected adverse events were reported, and no bleeding at the operative site was observed. All expect one child recovered to normal daily activities by the end of the first week. Conclusion: Pain is a common outcome in children after strabismus surgery, and scheduled analgesic rather than ‘Pro Re Nata’ (PRN) treatment should be prescribed for 2-3 days after surgery.