Archives of Anesthesiology and Critical Care 2017. 3(2):308-312.

Delirium and Pain after Strabismus Surgery in Children Undergo General Anesthesia: A Comparison of Paracetamol and Meperidine
Hossein Sadrossadat, Ailar Ahangari, Shaqayeq Marashi, Amir Abbas Yaghooti


Background: Strabismus surgery under general anesthesia is one of the most common ophthalmic procedures in children with emergence delirium as an important post-operative complication. Additionally, postoperative pain is another important issue which is considered as a contributing factor to emergence delirium. We conducted a study to compare meperidine with paracetamol on postoperative pain and emergence delirium.

Methods: This double blind randomized clinical trial was carried out on 60 children underwent elective strabismus surgery under general anesthesia. Patients were randomly allocated in two groups of 30 that received intravenous meperidine (1mg/kg) or paracetamol (15 mg/kg). Severity of pain were assessed one minute after extubation and every 5 minutes up to 1 hour by using CHEOPS and PAED was used for assessment of emergence delirium by time interval of every 10 minutes up to 30 minutes. Other complications such as bronchospasm, laryngospasm, nausea and vomiting were also recorded.

Results: Pain severity was significantly higher is in paracetamol group while in meperidine group no patients received additional fentanyl in recovery room and emergence delirium was lower 30 minutes after surgery.

Conclusion: Although meperidine and paracetamol are both effective in reducing incidence of emergence delirium and controlling postoperative pain after strabismus surgery, meperidine is significantly more efficient.


meperidine; paracetamol; postoperative pain; emergence agitation; strabismus

Full Text:



Robaei R, Rose KA, Kifley A, Cosstick M, Ip JM, Mitchell P. Factors associated with childhood strabismus: findings from a population-based study. Ophthalmology. 2006; 113(7):1146-53.

Rodgers A, Cox RG. Anesthetic management for pediatric strabismus surgery: Continuing Professional Development. Can J Anaesth. 2010; 57(6):602-17.

Donahue SP. Clinical practice. Pediatric strabismus. N Engl J Med. 2007; 356(10):1040-7.

Ribeiro GB, Bach AGZ, Faria CM, Anastásia S, Almeida HC. Quality of life of patients with strabismus. Arq Bras Oftalmol. 2014; 77(2):110-3

Escardo-Paton JA, Harrad RA. Duration of conjunctival redness following adult strabismus surgery. J AAPOS 2009; 13(6):583-6.

Vlajkovic GP, Sindjelic RP. Emergence delirium in children: many questions, few answers. Anesth Analg. 2007; 104(1): 84-91.

Kim J, Kim SY, Lee JH, Kang YR, Koo BN. Low-dose dexmedetomidine reduces emergence agitation after desflurane anaesthesia in children undergoing strabismus surgery. Yonsei Med J. 2014; 55(2):508-516.

Cho EJ, Yoon SZ, Cho JE, Lee HW. Comparison of the effects of 0.03 and 0.05 mg/kg midazolam with placebo on prevention of emergence agitation in children having strabismus surgery. Anesthesiology. 2014; 120(6):1354-61.

Jung HJ, Kim JB, Im KS, Oh SH, Lee JM. Effect of ketamine versus thiopental sodium anesthetic induction and a small dose of fentanyl on emergence agitation after sevoflurane anesthesia in children undergoing brief ophthalmic surgery. Korean J Anesthesiol. 2010; 58(2):148-52.

S Rhiu, SA Chung, WK Kim, JH Chang, SJ Bae, JB Lee. The efficacy of Intravenous ketorolac for pain relief in single-stage adjustable strabismus surgery: a prospective, randomized, placebo-controlled trial. Eye. 2011; 25(2):154–160

Joo J, Lee S, Lee Y. Emergence delirium is related to the invasiveness of strabismus surgery in preschool-age children. J Int Med Res. 2014; 42(6):1311-22.

Chen J, Li W, Hu X, Wang D. Emergence agitation after cataract surgery in children: a comparison of midazolam, Propofol and ketamine. Paediatr Anaesth. 2010; 20(9):873-9.

Bae JH, Koo BW, Kim SJ, Lee DH, Lee ET, Kang CJ. The effects of Midazolam administered postoperatively on emergence agitation in pediatric strabismus surgery. Korean J Anesthesiol. 2010; 58(1):45-9.

Moir MS, Bair E, Shinnick P, Messner A. Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy. Laryngoscope. 2000; 110(11):1824-7.

Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med. 2002; 347(14):1094-103.

Mizrak A, Erbagci I, Arici T, Ozcan I, Ganidagli S, Tatar G, et al. Ketamine versus propofol for strabismus surgery in children. Clin Ophthalmol. 2010; 4:673-9.

Mizrak A, Erbagci I, Arici T, Avci N, Ganidagli S, Oner U. Dexmedetomidine use during strabismus surgery in agitated children. Med Princ Pract. 2011; 20:427-32.

Engelhardt Th., Steel E., Johnston G., Veitch D.Y. Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine. Paediatr Anaesth. 2003; 13(3):249-52.

Ekemen S, Yelken B, Ilhan H, Tokar B. A comparison of analgesic efficacy of tramadol and Pethidine for management of postoperative pain in children: a randomized, controlled study. Pediatr Surg Int. 2008; 24(6):695-8.

Y. Demiraran, B. Kocaman, R. Y. Akman. A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children. Br J Anaesth. 2005; 95(4): 510-13.

Alhashemi JA, Daghistani MF. Effects of intraoperative i.v. acetaminophen vs i.m. Meperidine on post-tonsillectomy pain in children. Br J Anaesth. 2006; 96(6):790-5.

Shende D, Das K. Comparative effects of intravenous ketorolac and Pethidine on perioperative analgesia and postoperative nausea and vomiting (PONV) for pediatric strabismus surgery. Acta Anaesthesiol Scand. 1999; 43(3):265-9.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.