Transcaruncular double injection technique for peribulbar anesthesia in vitreoretinal surgery.

Abstract

Local anesthesia is commonly adopted in vitreoretinal surgery to reach painless and akinesia surgical condition. Currently, peribulbar anesthesia (PBA) and subtenonian injection (STN) are the most widely used methods. We propose a transcaruncular double injection peribulbar technique (TRS) and aim to compare it with both standard PBA and STN injections. A total of 105 patients underwent either TRS or PBA or STN. Numerical Rating Scale (NRS) was used to assess pre, post and intraoperative pain. Best akinesia score, onset and duration of akinesia were evaluated by two independent graders. The need for supplementary injection was also registered. TRS group was characterized by a lower intraoperative NRS variation and absolute NRS score both at the beginning of surgery (p 0.046), after 30 minutes (p 0.032) and at the end of surgery (p 0.002) compared to the other groups. TRS group also showed better akinesia score (p 0.004), fastest onset (p 0.002) and longer duration (p 0.042) compared to both PBA ad STN. No injection related complications were reported in the 3 groups. the newly proposed transcaruncular PBA provided superior pain control and akinesia level with no additional adverse events.