Ultrasound navigation during retrobulbar blockade in children with retinoblastoma and enucleation of the eyeball

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Abstract

BACKGROUND: The retrobulbar block in children is used to enucleate analgesia in the intra- and postoperative period and prevent oculocardiac reflex (OCD), postoperative nausea, and vomiting. However, when the block is performed blindly, it results in serious complications.

AIM: This study aimed to evaluate the efficacy and safety of a retrobulbar block performed under ultrasound guidance compared with a retrobulbar block performed blindly during enucleation of the eyeball in children with retinoblastoma.

MATERIALS AND METHODS: A prospective randomized controlled trial was performed. The study included 40 patients who met the inclusion criteria. The patients were divided into two groups: 20 patients who underwent ultrasound-guided retrobulbar blockade (RBВ + ultrasound) and 20 patients who underwent blindly retrobulbar blockade (RBВ).

RESULTS: There was an insignificant decrease in intraoperative opioid requirements in the RBB + ultrasound group, where the average dose of fentanyl was 4±1.4 μg/kg, and in the RBB group, 4.7±0.8 μg/kg (p <0.05).

The time before the administration of the first dose of analgesic in the postoperative period was 4.7±0.8 h in the RBB group and 11.7±3.3 h in the RBB + ultrasound group (p <0.05). VAS and CHIPPS scores obtained 6 h after the end of surgery in the RBB + ultrasound and RBB groups were 1.8 (1.2; 2) and – 2.5 (3.8; 4.5) points (p <0.05), respectively.

CONCLUSION: There was no statistically significant difference between the time of the retrobulbar blockade under ultrasound guidance and the retrobulbar regional block performed blindly. Retrobulbar blockade performed under ultrasound guidance provides a decrease in intraoperative opioid requirements, stable intraoperative hemodynamics, and longer postoperative analgesia.

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About the authors

Ekaterina I. Belousova

Blokhin National Medical Research Center of Oncology

Email: e.belousova36@gmail.com
ORCID iD: 0000-0001-9602-3052

Ph.D.

Russian Federation, 23, Kashirskoe sh., Moscow, 115478

Nune V. Matinyan

Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical University

Email: n9031990633@yandex.ru
ORCID iD: 0000-0001-7805-5616
SPIN-code: 9829-6657

DSc

Russian Federation, 24, Kashirskoe sh., Moscow, 115478; Moscow

Anastasia A. Tsintsadze

Blokhin National Medical Research Center of Oncology

Email: anestesia228@mail.ru
ORCID iD: 0000-0003-1897-0331

Ph.D.

Russian Federation, 23, Kashirskoe sh., Moscow, 115478

Leonid A. Martynov

Blokhin National Medical Research Center of Oncology

Email: leonid.martynov@gmail.com
ORCID iD: 0000-0001-9013-2370
SPIN-code: 5278-1343
Russian Federation, 23, Kashirskoe sh., Moscow, 115478

Dmitry A. Kuznetsov

Blokhin National Medical Research Center of Oncology

Email: cbric89@mail.ru
ORCID iD: 0000-0003-3569-5255
SPIN-code: 3140-2275
Russian Federation, 23, Kashirskoe sh., Moscow, 115478

Ekaterina A. Kovaleva

Blokhin National Medical Research Center of Oncology

Author for correspondence.
Email: Mel_amory@mail.ru
ORCID iD: 0000-0001-9492-034X
Russian Federation, 23, Kashirskoe sh., Moscow, 115478

Tatyana L. Ushakova

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Email: ushtat07@mail.ru
ORCID iD: 0000-0003-3263-6655
SPIN-code: 2065-8779

DSc

Russian Federation, 24, Kashirskoe sh., Moscow, 115478; Moscow

Vladimir G. Polyakov

Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical University; Russian Medical Academy of Continuous Professional Education

Email: vgp-04@mail.ru
ORCID iD: 0000-0002-8096-0874
SPIN-code: 8606-3120

DSc, Professor

Russian Federation, 23, Kashirskoe sh., Moscow, 115478; Moscow; Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Midriaz on the right after RBB (photo from the personal archive of the group of authors)

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2. Fig. 2. Sensor position. Sonogram of the eyeball and orbit. The introduction of the needle in the plane of the beam (in plain) on the right (photo from the personal archive of the group of authors)

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Свидетельство о регистрации СМИ ФС 77 - 55827 от 30.10.2013 г. выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). 
Свидетельство о регистрации СМИ ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г. выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).


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