Anesthesia For Vitreoretinal Surgery Research Articles

Sub-Tenon versus peribulbar anesthesia in vitreoretinal surgery: A retrospective analysis in a tertiary eye care center

Aim: The aim of this study was to compare the efficacy of sub-Tenon and peribulbar anesthesia in vitreoretinal surgeries. Methods: This was a retrospective study where patients who received peribulbar or sub-Tenon anesthesia during vitreoretinal surgeries between July 2023 and September 2023 were included. Lid movements, subconjunctival hemorrhage, chemosis, and akinesia were evaluated after anesthesia was injected in the two groups. Pain score was evaluated at the time of anesthesia, intraoperatively, and postoperatively after 1 h. Results: We included 108 patients, of which 58 were given peribulbar and 50 had sub-Tenon anesthesia and had mean ± standard deviation age of 56.8 ± 12.6 years and 57.90 ± 13.0 years, respectively (P = 0.67). Baseline, intraoperative, and postoperative (at 1 h after surgery) systolic blood pressure (BP), diastolic BP, and pulse rate were similar in both groups. None of the patients had any systemic complications in both the peribulbar and sub-Tenon groups. The mean pain score at postoperative 1 h was similar in both groups (P = 0.58). At postoperative 1 day, two patients had ecchymosis in the peribulbar group. Eighteen cases had lid edema in the peribulbar group compared to no lid edema in the sub-Tenon group (P < 0.001). Conclusion: Sub-Tenon anesthesia is a simple, safe, and less traumatic technique that is as good as peribulbar in terms of providing analgesia. Although sub-Tenon could not produce total akinesia in most of the cases, the surgeon was able to operate comfortably with negligible chance of anesthesia-related complications. However, the anesthetist also plays an important role in a multidisciplinary approach in the management of vitreoretinal surgeries.

Transcaruncular double injection technique for peribulbar anesthesia in vitreoretinal surgery.

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.

Current Trends in Vitreoretinal Anesthesia

ABSTRACT Purpose To evaluate the current practices in anesthesia for vitreoretinal surgery in a variety of practice locations and types. Design Cross-Sectional Survey Based Study Participants 2,638 retinal specialists from academic and private practices. Methods Participants were questioned in detail regarding their preferences for topical, regional, or general anesthesia for a variety of case types. Main Outcome Measures Utilization of local or general anesthesia, providers of anesthesia, and selection of anesthesia for vitreoretinal procedures and open globe injuries. Results The cumulative response rate was 23% (597/2,638). Of the 556 respondents who regularly perform surgery, regional anesthesia was more commonly administered by ophthalmologists than anesthesiologists. Intraconal anesthesia was used in 319/555 (57%) of cases and was more commonly used in the United States (US) than non-US where extraconal and sub-Tenon’s anesthesia were more common (p Conclusion Regional anesthesia with MAC is the most common method for vitreoretinal procedures, but GA is still a common option especially for scleral buckling and trauma.

Сравнительный анализ использования местных анестетиков хирокаина и лидокаина для сочетанной анестезии в эндовитреальной хирургии

Сравнительный анализ использования местных анестетиков хирокаина и лидокаина для сочетанной анестезии в эндовитреальной хирургии

The Effect of Low-Dose Dexmedetomidine as an Adjuvant to Levobupivacaine in Patients Undergoing Vitreoretinal Surgery Under Sub-Tenon's Block Anesthesia.

This study evaluated the motor and sensory block durations and the postoperative analgesic effects of adding dexmedetomidine to levobupivacaine for sub-Tenon's block anesthesia in patients undergoing vitreoretinal surgery. Motor and sensory block durations were considered as a primary end point. Sixty ASA physical status I to III patients subjected to vitreoretinal surgery under sub-Tenon's block anesthesia were randomly divided equally into 2 groups, depending on the local anesthesia solution used, to receive 4 mL of 0.75% levobupivacaine plus 15 IU hyaluronidase diluted with 1 mL normal saline (group L) or 4 mL of 0.75% levobupivacaine plus 15 IU hyaluronidase and 20 μg dexmedetomidine diluted with 1 mL normal saline (group LD). The total volume of the local anesthesia solution used was 5 mL. Motor block and sensory block durations were evaluated until the return of normal motor and sensory functions. The sedation level was assessed during the surgery period and 24 hours postoperatively, together with the degree of postoperative pain. The total diclofenac consumption (milligrams) and the number of patients (%) who required tramadol were recorded. The sleep quality of the first postoperative night was assessed using the Consensus Sleep Diary. Dexmedetomidine provided significantly longer motor block duration (371.90 ± 48.10 vs 264.13 ± 41.48 minutes, P = 0.001) and significantly longer sensory block duration (499.10 ± 51.76 vs 344.33 ± 45.46 minutes, P = 0.001) compared with levobupivacaine alone. Furthermore, the patients in the dexmedetomidine group achieved significantly (P < 0.0001) greater levels of sedation during the surgery period and for 12 hours postoperatively together with significantly (P < 0.0001) lower values of verbal numeric rating scale of pain between the periods from 4 to 12 hours postoperatively compared with the patients in the levobupivacaine group. There was significantly (P = 0.001) less diclofenac consumed (mg) in the dexmedetomidine group. The patients in the dexmedetomidine group reported significantly higher rates of good sleep quality on the first postoperative night (70%) compared with those in the levobupivacaine group (30%; P < 0.0001). For patients undergoing vitreoretinal surgery, adding 20 μg of dexmedetomidine to levobupivacaine for sub-Tenon's block anesthesia in vitreoretinal surgery extended the motor and sensory block durations and provided more effective postoperative analgesia with improvement in the sleep quality in the first postoperative night compared with levobupivacaine alone.

A qualitative study of regional anaesthesia for vitreo‐retinal surgery

The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery. Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times; this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited. An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics. Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts. Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block; 'experiencing': the experience of regional ocular anaesthesia; 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored; and 'knowing': when further surgery was required and past experiences were recalled. The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function.

The efficacy of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in vitreoretinal surgery.

Background:We evaluated the anesthetic efficacy and the postoperative analgesic effects of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in patients undergoing primary vitreoretinal surgery.Methods:We investigated 120 patients subjected to vitreoretinal surgery under peribulbar anesthesia. They were randomized into two equal groups according to the local anesthetic (LA) used, namely, 0.75% levobupivacaine or 0.75% ropivacaine, both with the addition of hyaluronidase. Nerve block was carried out by injection of 5–7 mL of the LA using single injection percutaneous peribulbar anesthesia with a short needle.Results:When compared with 0.75% ropivacaine, 0.75% levobupivacaine provided more successful akinesia at 10 min after block (P=0.026), fewer supplementary injections (P=0.026), and less volume (mL) was used (P=0.031). Also, levobupivacaine provided significantly longer motor block duration (342±27 min versus 206±40 min, P=0.001) and significantly longer sensory block duration (513±24 min versus 394±11 min, P=0.001) when compared with ropivacaine. In the postoperative period, the patients in the levobupivacaine group achieved lower values of verbal numeric rating scale of pain compared with patients in the ropivacaine group among the period from 4 to 12 h. Also, there were significantly (P=0.001) lower diclofenac consumption (mg) and the percentage of patients who required tramadol rescue medication were significantly less (P=0.034) in the levobupivacaine group compared with the ropivacaine group.Conclusion:We are concluding that, at equipotent doses and concentrations, 0.75% levobupivacaine provides more effective peribulbar anesthesia and more effective postoperative analgesia for vitreoretinal surgery compared with 0.75% ropivacaine.

Comparison of 0.5% Levobupivacaine, 0.5% Bupivacaine, and 2% Lidocaine for Retrobulbar Anesthesia in Vitreoretinal Surgery

The authors compared the efficacy of local anesthetics levobupivacaine, bupivacaine, and lidocaine for retrobulbar anesthesia in vitreoretinal surgery. A total of 135 patients presenting for vitreoretinal surgery under local anesthesia were included in the study. Patients were randomly allocated to one of three groups. Group LB patients received 5 mL of 0.5% levobupivacaine, Group L patients received 5 mL of 2% lidocaine, and Group B patients received 5 mL of 0.5% bupivacaine for retrobulbar anesthesia via inferotemporal injection. Sensory and motor block durations were recorded. Intraoperative and postoperative pain was assessed by using verbal pain scala. Anesthesia efficiency, patient and surgeon satisfaction, and akinesia were assessed by using point scales. Hemodynamic data and adverse events were recorded. The demographic characteristics of patients, duration of surgery, and hemodynamic data in both groups were similar. The duration of motor and sensory block was longer in levobupivacaine and bupivacaine groups than lidocaine group. Pain on injection was found more frequent in Group L and Group B than Group LB and the difference between the Groups LB and B was significant (p<0.05). Surgeon and patient satisfaction were also higher and intraoperative pain was less in levobupivacaine group than lidocaine and bupivacaine groups. Levobupivacaine provides longer motor and sensory block duration and higher surgeon and patient satisfaction than lidocaine and bupivacaine when used for retrobulbar anesthesia in vitreoretinal surgery.

Effect of Volume Used in Sub-Tenon’s Anesthesia on Efficacy and Intraocular Pressure in Vitreoretinal Surgery

Purpose: To compare the effect of volumes used in sub- Tenon’s anesthesia on efficacy and intraocular pressure (IOP) in vitreoretinal surgery. Methods: A prospective clinical trial was conducted on patients undergoing sub-Tenon’s anesthesia for vitreoretinal surgery. Patients were randomized to receive either 3-, 5- or 7-ml volumes of anesthetic solution. IOP were measured immediately prior to injection, immediately after injection and at 2, 5 and 10 min after injection. Pain scores were assigned using a numerical visual analogue scale immediately after surgery, and again on postoperative day 1. Results: A total of 108 patients (119 eyes) were studied, including 35 eyes in the 3-ml group, 48 eyes in the 5-ml group, and 36 eyes in the 7-ml group. There were significant elevations in mean IOP following injection in all groups, and a trend for larger rises in IOP with larger volumes of anesthesia (p < 0.01). Mean IOP were elevated after injection, and reduced at all time intervals. However, the reduction in the 3-ml group took levels to preinjection amounts. There were no significant differences in patient-reported pain scores among the groups when assessed immediately after surgery or on postoperative day 1. The incidence of chemosis and high IOP elevations (≥40 mm Hg) were more frequent in the 7-ml group (p < 0.05). Conclusions: Sub-Tenon’s anesthesia is effective in vitreoretinal surgery. It would appear that a 3–5-ml volume of anesthetic is safe, when considering the associated complications.

Peribulbar and Retrobulbar Combined Anesthesia for Vitreoretinal Surgery using Ropivacaine

To evaluate the efficacy and clinical effects of local retrobulbar anesthesia using ropivacaine in vitreoretinal surgery. Prospective study. A total of 919 vitreoretinal operations were followed. The operations were divided into three groups, depending on the degree of anesthesia needed. Group A: Vitrectomies with episcleral procedures (208 vitrectomies for detached retina or perforating trauma). Group B: Episcleral procedures only (410 operations for detached retina without vitrectomy). Group C: Vitrectomies without episcleral surgery (301 operations for macular pucker or hole, proliferative diabetic retinopathy, or silicone oil removal). Anesthesia was administered using a 23-gauge Atkinson-type retrobulbar needle, after topical anesthesia. Six mL of the solution containing 7.5 mg ropivacaine/mL were injected into the peribulbar space, and the other 4 mL deeper, into the retrobulbar space. The degree of infiltration of the palpebral region, the motor block in the extrinsic ocular muscles, and pain felt were checked and rated. Swelling of lids was seen in 885 patients (96%); in 21 (2%) swelling was partial. In 13 patients (1%) there were no signs of infiltration. The motor block was total in 801 (87%) eyes, while 118 (12%) had reduced ocular movements. The degree of anesthesia was as follows, considering the three groups together: no pain = 855 (93%) patients; moderate pain = 44 (4%) patients; very strong pain = 20 (2%) patients. No adverse events or side effects were observed. Ropivacaine used for retrobulbar-peribulbar combined anesthesia in vitreoretinal surgery showed excellent clinical efficacy as regards analgesia and muscle akinesia.