Retrobulbar bupivacaine irrigation for postoperative pain after scleral buckling surgery. A prospective study

The authors conducted a prospective, randomized, double-masked clinical trial to determine if retrobulbar irrigation with bupivacaine hydrochloride 0.75% (Marcaine) has an effect on postoperative pain after scleral buckling surgery. Fifty consecutive patients undergoing scleral buckling under general anesthesia were randomized to receive either bupivacaine or balanced salt solution as a retrobulbar irrigation at the end of their retinal detachment procedure. Of the 25 patients who received bupivacaine, only three (12%) required parenteral pain relief in the first 24 hours after surgery. This was statistically significant when compared with the 18 (72%) of 25 patients requiring parenteral pain relief in the placebo group (P less than 0.0001). In addition, when questioned about their perception of the degree of postoperative pain, patients in the control group rated their level of pain as significantly more severe than did patients in the bupivacaine group. The authors conclude that retrobulbar irrigation with bupivacaine is a safe and effective way to achieve postoperative pain relief after surgery for scleral buckling.