Use of an orbital epidural catheter to control pain after orbital implant surgery

Background: The surgical placement of orbital implants for eviscerations, e nucleations, and secondary implantations can cause severe postoperative pai n that may not be relieved with high doses of narcotics. We analyzed the ef fectiveness of a method for postoperative pain control in orbital implant s urgery using an orbital epidural pain catheter connected to a patient-contr olled analgesia bupivacaine hydrochloride pump. Methods: One hundred nineteen patients undergoing orbital hydroxyapatite im plant surgery received placement of an orbital epidural catheter for the in fusion of local anesthetics at the conclusion of their surgery. Patients we re asked to gauge their level of comfort into the following 3 categories: t otal, some, or no pain relief in the first week after surgery. A separate n umerical grading scale was used to further quantitate pain. Blood samples w ere collected in 4 patients to assess the systemic levels of bupivacaine. Results: Most patients (88.2%) responded with total or some pain relief, wi th only 11.8% suffering severe pain. The mean numerical pain score was 2.8, within a range of 0 (no pain) to 10 (severe pain). The average plasma bupi vacaine level in the 4 patients in whom this was measured was 0.38 mu g/mL, which is well below the toxic level of 4.0 mu g/mL. Furthermore, there wer e only 5 minor complications caused by the catheters, ie, 1 retrobulbar hem orrhage and 4 catheters that did not work. No permanent problems arose from any of the complications. Conclusions: The orbital epidural pain catheter is an effective means to ac hieve postoperative pain control after orbital implant surgery. The simple technique of insertion and management of the catheters was well tolerated i n our patient population.