A two-year prospective study comparing lidocaine 2% jelly versus peribulbar anaesthesia for 25G and 23G sutureless vitrectomy

Abstract

To evaluate the efficacy of topical lidocaine 2% gel with or without peroral preoperative sedation as an alternative anaesthetic method in sutureless vitreoretinal surgery. A prospective study was designed to assess the intraoperative and postoperative pain, using a visual analogue scale (VAS) in three groups of patients, comprised of 23 patients each. The first group included cases that were operated with 25-gauge (25G) instruments under topical anaesthesia with lidocaine jelly, the second group with 23-gauge (23G) under the same topical anaesthesia and finally the third group (control group) with sutureless (23- or 25-gauge) vitrectomy under peribulbar anaesthesia. Mann Whitney U test was used to compare the results. The subjective surgeon's opinion about the difficulty of each procedure was recorded on a 1-5 scale and the results were evaluated with a chi-square test. No statistically significant difference in the level of pain was detected between the three groups. Topical anaesthesia vitrectomy procedures were performed more easily (p = 0.0002) with 23-gauge than with 25-gauge instruments. The painful steps of the surgery that were capable of causing moderate to severe pain were endolaser, scleral indentation and peribulbar injection. The goal of the operations was accomplished in all cases. Lidocaine 2% jelly with or without peroral preoperative morphine and dixyrazine offers adequate analgesia to perform sutureless vitrectomy. Lack of akinesia does not prevent a successful surgical result.