The use of subtenon ropivacaine in managing strabismus with adjustable sutures

Background: Squint angle alterations with the use of adjustable sutures aft er strabismus surgery can be painful. Ropivacaine is a long-acting local an esthetic that, at low doses, produces sensory block with limited nonprogres sive motor block. Method: We performed a double-blind, randomized, pilot st udy using subtenon ropivacaine or placebo at the time of surgery in patient s undergoing adjustable suture surgery. Surgery was performed by the same s urgeon in each case. Later in the day, the same surgeon adjusted the suture s. At the time of adjustment, the patient recorded pain using a linear pain score, and the surgeon recorded ease of adjustment using a linear score. T he results of surgery were noted at 4 weeks. Results: Ten patients were ran domized to receive ropivacaine and 11 to receive placebo. All 10 of the rop ivacaine group acid 9 of the placebo group had suture adjustment. In the ro pivacaine group, there was a significantly lower pain score (P<.05, Mann-Wh itney U test) but no significant difference in ease of adjustment. There ap peared to be no demonstrable difference in the results of surgery between t he 2 groups. Conclusion: Ropivacaine appears to reduce the pain of postoper ative suture adjustment without adversely affecting the final outcome, alth ough it does not appear to ease the adjustment itself. This small pilot stu dy shows promising results in postoperative analgesia in these patients, al though further larger trials are recommended.