topical pain relief before ROP screening

Specialties NICU

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We have introduced Proxymetacaine anaesthetic eye drops before retinopathy screening in our NICU. It isn't licensed for neon ates in the UK and some staff are worried about potential side effects from systemic absorption. Does anyone have experience of using Proxymetacaine (I think in US has different name but anaesthetic eye drops), and has anyone experienced any side effects from it? Thanks for your advice.:)

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Specializes in NICU.
We have introduced Proxymetacaine anaesthetic eye drops before retinopathy screening in our NICU. It isn't licensed for neon ates in the UK and some staff are worried about potential side effects from systemic absorption. Does anyone have experience of using Proxymetacaine (I think in US has different name but anaesthetic eye drops), and has anyone experienced any side effects from it? Thanks for your advice.:)

Proxymetacaine is known as proparacaine here in the US. It's not used in my unit, but it is recommended by the American Academy of Pediatrics for pain management with ROP exams (Pediatrics, 2006, pp. 572-576).

The official word on proxymetacaine in the UK seems to date to the BNF-C (2007) where it is not recommended for premature babies due to the immaturity of their ability to metabolize this med. However, as there have been several studies documenting no adverse effects related to the use of proparacaine/proxymetacaine in preemies, the UK Retinopathy of Prematurity Guideline states only that "a topical anaesthetic of choice [i.e. proxymetacaine or oxybuprocaine] should be used prior to ROP screening" (Royal College of Paediatrics and Child Health, Royal College of Ophthalmologists, British Association of Perinatal Medicine, BLISS; 2008).

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Specializes in NICU, PICU, educator.

We use it for laser surgery, but not routine exams. We premedicate with Tylenol and then x 2 after. Haven't really noticed any SE from it.

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Specializes in NICU.

Just Tylenol and a topical anesthetic for laser? I think most, if not all, of our kids get Fentanyl, and often vecuronium too.

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Specializes in NICU, PICU, educator.

Whoops..need to clarify...Tylenol before and after routine exam. We conscious sedate with Fent and Versed for laser. Are all your kids intubated for laser? We then give Tylenol for 24 hours after laser

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Specializes in NICU.
Whoops..need to clarify...Tylenol before and after routine exam. We conscious sedate with Fent and Versed for laser. Are all your kids intubated for laser? We then give Tylenol for 24 hours after laser

Ohh, gotcha. That makes much more sense.

The ones who are vec'd are already intubated, I can't think off the top of my head of anyone getting electively tubed for laser.

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