Preoperative topical lidocaine in pediatric squint surgeries: a randomized clinical trial

Aims To assess the safety and efficacy of lidocaine gel 2% used in pediatric squint surgeries to prevent the oculocardiac reflex intraoperatively and reduce postoperative pain and agitation. Settings and design This single-blinded, randomized trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods Forty-eight children (2–13 years old) of both sexes scheduled for squint surgeries were randomly allocated into two groups (24 patients each): the lidocaine gel group and the control group. In the experimental group, we applied lidocaine gel 2% abundantly below both eyelids of the surgical eye for at least 3 min before surgical incision, while nothing was applied to patients in the control group. Patients were monitored intraoperatively and postoperatively, and the outcomes were recorded. Results There was a lower median postoperative face, leg, activity, cry, and consolability scale in the lidocaine gel group (3.0, interquartile range=2.5–5.0) than in the control group (4.0, interquartile range=1.5–7.0) with no significant difference (P=0.770). The incidence of bradycardia was lower with lidocaine gel 2% use (16.7%) compared with the control group (41.7%), but this difference was not statistically significant (P=0.057). We found no complications except for two patients in the control group who had fever and flushing due to atropine administration. Conclusion Application of lidocaine gel 2% below both lids of the surgical eye in pediatric squint surgery under general anesthesia is safe with no observed systemic side effects. However, it has no adjuvant effects in reducing postoperative pain and agitation or preventing intraoperative oculocardiac reflex.