Postoperative Patient Comfort Research Articles

Comparison of the Transarterial Axillary Block and the Ultrasound-Guided Infraclavicular Block for Upper Extremity Surgery

The transarterial axillary block and the ultrasound-guided infraclavicular block are both effective methods of anesthetizing the upper extremity. This study compares these methods with respect to subjective postoperative dysesthesias, block adequacy, patient comfort, and patient satisfaction. Two hundred thirty-two patients were randomized to receive an ultrasound-guided infraclavicular block or a transarterial axillary block for upper extremity surgery. Block placement, motor and sensory testing, and block adequacy data were recorded. The subjects were contacted by a blinded research assistant at 2 and 10 days postoperatively to assess for the presence of dysesthesias and pain and to assess patient satisfaction. The 2 techniques were similar with respect to block performance time and adequacy of the block for surgery. There was no significant difference between the blocks in terms of postoperative dysesthesias (23.9% in the axillary group vs 17.1% in the infraclavicular group at 2 days, P = 0.216, and 11.0% vs 6.31% at 10 days, P = 0.214). None of the dysesthesias were permanent. The infraclavicular block had a lower incidence of paresthesias during placement (P = 0.035) and was associated with less pain at the block site (P = 0.010 at 2 days, P = 0.002 at 10 days). More patients were willing to undergo the infraclavicular block as a future anesthetic when compared with the axillary block (P = 0.025 at 10 days). There is no significant difference between the 2 techniques in terms of adequacy for surgery and subjective postoperative dysesthesias. The ultrasound-guided infraclavicular block is associated with greater patient comfort and willingness to undergo the same anesthetic when compared with the transarterial axillary block.

Surgical complications after endoscopic transsphenoidal pituitary surgery

Between January 2004 and June 2007 we conducted a retrospective analysis to assess post-operative complications related to endoscopic pituitary surgery in a series of 150 patients. Patients were treated with an endoscopic endonasal transsphenoidal approach to the sellar region for removal of pathological sellar and suprasellar lesions. We analysed the complications in groups according to the anatomical structures of the approach and the functional systems of the pituitary gland (anterior and posterior endocrine systems), and compared them to a large historical series using the traditional microsurgical transsphenoidal approach. Overall, we observed a decreased incidence of complications with respect to the surgical trauma, the functionality of the pituitary gland and post-operative patient comfort. We believe that the reduction of the complication rate observed in this study was mainly due to the wide structural overview offered by the endoscope as well as the anatomically direct, and therefore minimally invasive, character of the procedure. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Furthermore, close cooperation between a multidisciplinary team consisting of endocrinologists, neurosurgeons, ear, nose and throat surgeons, radiologists, and radiation oncologists is of utmost importance.

A Challenging Problem That Concerns the Aesthetic Surgeon

Postoperative nausea and vomiting (PONV) are among the most common adverse events in the postoperative period. This is especially disastrous in aesthetic surgery; it may cause hematoma, wound dehiscence, and patient dissatisfaction. The purpose of this study was to evaluate the incidence of PONV after aesthetic surgery procedures, and to determine the risk factors for PONV. Two hundred and twelve patients undergoing the most common aesthetic surgical procedures were included into this study. Female gender, surgical site, and history of PONV were found to be significant risk factors, however, postoperative opiate use and history of motion sickness were not found to be significant risk factors for PONV. Those undergoing trunk surgery procedures appeared to be at higher risk than were those undergoing head and neck surgery procedures. Also, ondansetron was found to be more affective than metoclopramide. Risk factors for PONV must be questioned preoperatively. Patients with risk factors are good candidates for prophylaxis. As a result of the effective prevention of PONV, postoperative patient comfort and satisfaction should be more improved.

Selective and Nonselective Nonsteroidal Anti-inflammatory Drugs in Perianesthesia Pain Management

Despite advances in pain management techniques, there remains room for further improvement in optimizing postoperative patient comfort. Although nonsteroidal anti-inflammatory drugs (NSAIDs) that are more selective in the inhibition of the cyclooxygenase (COX) enzyme have become more popular over recent years, the use of traditional nonselective NSAIDs remains efficacious in reducing postoperative pain. Both nonselective and selective NSAIDs have an important role in perianesthesia pain management. This article reviews the benefits and risks of both nonselective NSAIDs and COX-2 NSAIDs in the perianesthesia period.

The current role of laparoscopic liver resection for the treatment of liver tumors

Laparoscopic liver resection (LLR) represents a natural extension of minimally invasive surgery. Several case-control studies have demonstrated that LLR is safe and feasible in carefully selected patients. LLR is associated with reduced operative blood loss and earlier recovery when compared with open surgery. In addition, oncologic clearance achieved with LLR is comparable to that achieved with open surgery. Improved cosmesis and postoperative patient comfort also argue in favor of LLR compared with open surgery. When considering whether a patient is suitable for LLR, the size and location of the neoplasm must be taken into account. Operator experience must also be considered as LLR is technically demanding and requires experience in conventional hepatobiliary surgery and advanced laparoscopy. The main indication for LLR is limited resection of superficial or peripherally located tumors. In the case of malignant tumors, LLR should be indicated only if a safe and effective oncologic resection can be performed, and the availability of laparoscopy should not change the indications for benign lesions. Ultimately, the future application of LLR will depend on how easily liver surgeons can master the technique and whether the long-term results of LLR can match those achieved with open resection.

Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study

Aim:To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision.Methods:Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery...

Addition of remifentanil to patient-controlled tramadol for postoperative analgesia

We have investigated whether, after major abdominal surgery, the addition of remifentanil to tramadol for intravenous patient-controlled analgesia improved analgesia and lowered pain scores, compared to a patient-controlled analgesia containing only tramadol. Sixty-two patients were allocated randomly to receive an intravenous patient-controlled analgesia with tramadol alone (T), or tramadol plus remifentanil (TR), in a double-blind randomized study. Whenever patients complained of pain, they were allowed to use bolus doses of tramadol (0.2 mg kg-1) or tramadol (0.2 mg kg-1) plus remifentanil (0.2 microg kg-1) mixture every 10 min without a time limit and background infusion. Discomfort, sedation, pain scores, total and bolus patient-controlled analgesia tramadol consumption, and side-effects were recorded for up to 24 h after the start of patient-controlled analgesia. Pain scores at rest were statistically significantly lower in the TR group at 6, 12 and 24 h than in T group (P < 0.05). Pain scores at movement and patient comfort scores were also found to be significantly lower in the TR group at 2, 6, 12 and 24 h than in the T group (P < 0.05). Although the TR group consumed less tramadol, there were no statistically significant differences in the cumulative tramadol consumptions between the groups at any time. However, the number of patients requiring rescue analgesia and average supplementary doses used was significantly higher in the T group than in the TR group (P < 0.05). After major abdominal surgery, adding remifentanil (0.2 microg kg(-1)) to tramadol (0.2 mg kg(-1)), with 10-min lockout times, for patient-controlled analgesia offered better postoperative pain relief and patient comfort, without causing any sedation or respiratory depression.

Invited commentary

I commend the authors for providing a prospective, randomized comparison of endovenous laser ablation (EVL) of the great saphenous vein with conventional surgical stripping in symptomatic patients. High ligation of the saphenofemoral confluence was, unfortunately, also performed in conjunction with laser ablation, which is generally not the current practice in the United States. Primary end points revealed less size of bruising with EVL at 4 weeks postoperatively, but quality of life and pain scores showed no difference. Secondary softer end points were not statistically different in the two groups, although there was a tendency in favor of the EVL. Despite these findings, the patients receiving laser ablation had longer sick leave than the patients having stripping. Thus, GSV laser ablation in this setting did not show any major advantage over surgical stripping. Obviously, there are differences in treatment aspects between Austria and the United States. In the United States, the EVL targeted energy dose is usually >20 to 30 J/cm, tumescence is obligatory (even when general anesthesia is used), the duration of wearing a compression stocking is shorter, and, rarely is low-molecular-weight heparin routinely used as thrombosis prophylaxis perioperatively. The impact of these factors on the result is unknown. Groin dissection and ligation is currently rarely performed with laser ablation of the GSV in the United States. It is of little value to translate the conclusions from this study to other reports of EVL without GSV ligation. Some surgeons, who are able to perform groin dissection, may still prefer to do so in conjunction with laser ablation. It is never done when the laser procedure is performed by nonsurgeons and in an office setting. This study does not support to continue GSV ligation with EVL, because there was no benefit to use the more expensive laser when it was combined with groin ligation. The same result could be achieved by inserting the inexpensive disposable stripper and removing the vein. Groin neovascularization is probably triggered by the exploration and ligation of saphenous tributaries and is frequently associated with recurrence after surgery. This phenomenon is largely avoided by the laser treatment with no groin dissection. Long-term randomized studies to evaluate this aspect are still lacking. Furthermore, it has been suggested that the risk of neovascularization may be substantially decreased when tributaries draining the abdominal wall are not ligated at the saphenofemoral confluence. Again, this aspect needs to be tested in randomized long-term studies. High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: Early results of a randomized controlled studyJournal of Vascular SurgeryVol. 47Issue 4PreviewThis study compared postoperative patient comfort and the surgical outcome of endovenous laser ablation (EVLA) or stripping of the great saphenous vein, both performed in conjunction with high ligation. Full-Text PDF Open Archive

High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: Early results of a randomized controlled study

This study compared postoperative patient comfort and the surgical outcome of endovenous laser ablation (EVLA) or stripping of the great saphenous vein, both performed in conjunction with high ligation. The study randomized 100 patients with primary trunk varicosities of the great saphenous vein (CEAP clinical class II to IV) to EVLA or stripping. The success of surgery was followed-up by duplex ultrasound imaging at 1, 4, and 16 weeks. Primary end points were the size of the hematoma 1 week after the operation and the preoperative disease-specific Chronic Venous Insufficiency Questionnaire (CIVIQ) quality of life score compared with 4 weeks postoperatively. Secondary end points were postoperative symptoms (pain, use of analgesics, paresthesia at the ankle, residual hematoma), complications, time taken to resume work, the patient's satisfaction with the cosmetic outcome, and the CIVIQ quality of life score at 16 weeks. The groups were well matched at baseline. In all, 95 patients could be followed up in accordance with the protocol. The treatment was successful in all patients. Endovenous laser ablation was associated with an occlusion rate of 100%. Hematomas were significantly smaller after EVLA (median [quartiles]) at 125 (55-180) cm(2) vs stripping 200 (123-269) cm(2) (P = .001). No difference was registered between groups for the CIVIQ quality of life score, with EVLA at -1.25 (-7.5-11.25) vs stripping at 4.38 (-5.94-14.38; P = .34). Several postoperative symptoms favored EVLA, but the only significant differences were seen in the minor side effects of surgery at 1 and 4 weeks and discomfort due to paresthesia at the ankle in the first postoperative week. EVLA was associated with a longer period of time until return to work (median [quartiles]) of 20 (14-25.5) days vs 14 (12.8-25) days (P = .054). Endovenous laser ablation combined with high ligation is safe and effective. Postoperative hematomas are significantly smaller than those after stripping. Short-term quality of life is at least as good as that after stripping. The long-term results warrant further investigation.

Use of a Novel Topical Hemostatic Sealant in Lacrimal Surgery: A Prospective, Comparative Study

FloSeal Matrix is a new, two-component (collagen granules and thrombin), topical hemostatic sealant. We prospectively evaluated the role of FloSeal Matrix in achieving hemostasis in dacryocystorhinostomy (DCR) surgery and its intraoperative characteristics (ease of use). We hypothesize that FloSeal will efficiently control bleeding in patients and eliminate the need for postoperative intranasal dressing. FloSeal was used during surgery in 10 consecutive patients undergoing DCR. A further 10 consecutive patients (comparative group) had DCR without FloSeal; nasal packing was performed to control postoperative bleeding. The severity of postoperative bleeding and patient comfort were compared between the two groups at three time points (immediately after surgery, 12 hours after surgery, and 24 hours after surgery). All patients in the comparative group had some degree of postoperative bleeding (minimal to severe), whereas the nine patients in the FloSeal group had none or minimal bleeding. The difference was statistically significant at all three measured time points (p = 0.047, 0.006, 0.05). The FloSeal group also had less postoperative discomfort (p = 0.0001). FloSeal Matrix is an effective hemostasis adjunct in patients undergoing lacrimal surgery. It has the added benefits of high patient satisfaction and ease of use.

Étude comparative de la vitrectomie transconjonctivale sans suture à 25-gauges avec celle à 20-gauges: À propos de 132 interventions

The transconjunctival sutureless vitrectomy (TSV 25) is a new technique showing substantial progress.A prospective study of 66 eyes of 66 patients who underwent surgical procedures using the transconjunctival standard vitrectomy system (TSV 25), between June 2004 and June 2005. The results were compared with the results in an equivalent population (66 patients) that underwent vitrectomy with a standard 20-gauge system.The most important differences between groups were 1) shorter surgical time in the 25-gauge vitrectomy group than in the 20-gauge group, with a mean time of 28.15+/-5.50 min for group 1 and 44.15+/-5.64 min for group 2 (p<0.001) and 2) lower mean postoperative intraocular tension in the first group of patients: in this group, the intraocular tension before surgery was a mean of 16.27+/-1.76 mmHg, decreasing to 12.17+/-1.36 mmHg, with a posterior increase to normal values of 15.06+/-1.66 mmHg at 7 days after surgery and a mean of 16.10+/-1.51 mmHg at 15 days. This decrease was not observed in the group of patients who underwent 20-gauge vitrectomy surgery. The other postoperative complications were similar in both groups except for four cases of anterior proliferation and two cases of fibrinous uveitis in group 2.The transconjunctival sutureless system (TSV 25) decreases surgical time and postoperative inflammation, with optimal postoperative patient comfort, but currently the accurate selection of patients remains important.

Die Verklebung des perkutanen Arbeitskanales nach kompletter Steinsanierung mit einem Gelatine-Matrix-Hämostypticum (Spongostan)

Parallel to the pilot project of Lee et al. which was published in February 2004, we also considered the possibility to seal the percutaneous nephrolithotomy (PCNL) access after complete stone removal via the local amplatz sheath. We started our project with the aims of increasing postoperative patient comfort, minimizing the risk of bleeding, and reducing postoperative cost and length of the hospital stay by performing this minimally invasive technique in 7 patients with medium stone burden. All patients were treated by removing stones via a working channel passing through the lower pole calix. After complete stone removal a hemostyptic gelatin powder (Spongostan, Johnson & Johnson) was prepared to a doughy paste, some drops of contrast medium were added and the whole material was introduced through the amplatz sheath into the working channel under imaging control. Imaging-controlled insertion of the doughy gelatin clot through the amplatz sheath into the parenchymal part of the channel alone resulted in immediate hemostasis in all patients. The amplatz sheath was retracted over a 28 Fr. rectal tube which was used to push the gelatin forward. There was no need for an additional tamponade of the renal fat capsule or the abdominal wall. After 2 minutes when no channel bleeding was apparent, the skin sutures were placed. Bleeding of the nephrostomy tract did not occur in any of the 7 patients. Average operating time was 50 minutes which was not significantly reduced by performing the new procedure. However, the hospital stay was reduced by 2 days. Two of the patients showed a single fever episode during the second postoperative evening. All patients presented with steady postoperative laboratory values without evidence of bleeding. Free urinary flow from the collecting system was controlled by means of ultrasound and urography. Similar to the recent usage of FloSeal/Baxter reported by Lee et al. we can confirm very reliable and immediate hemostasis using a pasty preparation of Spongostan (Johnson and Johnson) gelatin powder which was classified as being less toxic by the FDA in 2003 due to the lack of glutaraldehyde and bovine thrombin. Therefore, tubeless PCNL can be used for complete percutaneous clearance of stones without bleeding.

Ľinfiltration avec de la ropivacaïne, plus du lornoxicam, réduit la douleur postopératoire et la consommation ďopioïdes

To compare efficacy and patient outcome of wound infiltration with ropivacaine, lornoxicam, or their combination for control of pain following thyroid surgery. Eighty patients underwent thyroid surgery were randomly assigned to one of four groups. Before skin closure, local tissues were infiltrated with 12 mL saline in Group S, with 10 mL of ropivacaine 0.75% plus 2 mL saline in Group R, with 2 mL of lornoxicam (8 mg) plus 10 mL saline in Group L, and with 10 mL ropivacaine 0.75% plus 2 mL lornoxicam (8 mg) in Group RL. Pain scores, total and incremental meperidine con-eight, 12, 18, and 24 hr postoperatively. Time to first analgesic requirement, patient satisfaction, and duration of hospital stay were also compared after surgery. The pain scores in Group RL were significantly lower in the first 12 hr than in Group S, and in the first four hours than in Groups R and L (P < 0.01). The time to first analgesic requirement was significantly longer (14.8 +/- 8.4 hr vs 5.9 +/- 5.2 hr; P < 0.01), the total pethidine consumption was significantly less than Group S (34.0 +/- 33.0 mg vs 78.0 +/- 29.8 mg; P<0.001), return of gastrointestinal function, ambulation time, length of hospital stay (P < 0.05) were significantly shorter, and patient satisfaction (P < 0.01) was significantly better in Group RL than in Group S (P < 0.05). Wound infiltration with ropivacaine 0.75% plus lornoxicam 8 mg combination improved postoperative pain control and patient comfort, and decreased the need for opioids than the use of either drug alone.

Specialized Staff and Equipment for Weight Loss Surgery Patients: Best Practice Guidelines

To provide evidence-based guidelines on the specialized personnel, equipment, and physical plant required for safe and effective care of severely obese weight loss surgery (WLS) patients. We examined MEDLINE (Ovid and PubMed) and the Cumulative Index of Nursing and Allied Health Literature for articles on facilities resources for care of WLS patients published in English between January 1980 and March 2004. We queried several web sites for appropriate references; these included the Agency for Healthcare Research and Quality and the American College of Surgeons. The majority of reference material was descriptive and not specific to facilities resources for WLS patients. We identified a substantial body of literature on the general subject of patient safety; three of these articles were used to develop recommendations on the use of technology for medical error reduction. All other recommendations are based on 11 expert opinion reports. We recommended adequate training and credentialing for all medical staff; dedicated support and administrative personnel; and specialized interventional, diagnostic, operating room, and transport equipment. We specified needed adaptations to the physical plant and developed evidence-based guidelines for medical error reduction and systems improvements. Specialized resources and dedicated staff are needed to protect the health of WLS surgery patients and staff. Adaptations include preoperative preparation for safe means of patient transport; techniques of anesthesia and intraoperative exposure; provisions for postoperative recovery; and measures to assure postoperative patient safety, hygiene, and comfort.

Acute Postoperative Pain Management

ffective postoperative pain control is an essential compo-nent of the care of the surgical patient. Inadequate paincontrol, apart from being inhumane, may result in in-creased morbidity or mortality (1, 2). Evidence suggests that sur-gery suppresses the immune system and that this suppression isproportionate to the invasiveness of the surgery (3, 4). Goodanalgesia can reduce this deleterious effect. Data available indi-cate that afferent neural blockade with local anesthetics is themost effective analgesic technique. Next in order of effectivenessare high-dose opioids, epidural opioids and clonidine, patient-controlled opioid therapy, and nonsteroidal anti-inflammatoryagents (5).The advantages of effective postoperative pain managementinclude patient comfort and therefore satisfaction, earlier mo-bilization, fewer pulmonary and cardiac complications, a reducedrisk of deep vein thrombosis, faster recovery with less likelihoodof the development of neuropathic pain, and reduced cost of care.The failure to provide good postoperative analgesia is multi-factorial. Insufficient education, fear of complications associatedwith analgesic drugs, poor pain assessment, and inadequate staff-ing are among its causes.

Gallstones Spilled After Laparoscopic Surgery Cause Adhesions

Laparoscopic cholecystectomy has dramatically decreased hospital stay and improved postoperative patient comfort. The technique bears few complications, but in about 20% of cases, gallstones are inadvertently spilled. Usually, the surgeon does not remove them …

Comparison of bladder, oesophageal and pulmonary artery temperatures in major abdominal surgery

In this study we compared urinary bladder and oesophageal temperatures with the core temperature obtained from a pulmonary artery catheter in patients undergoing orthotopic liver transplantation. The bladder temperature was a closer approximation to pulmonary artery temperature in this group of patients than the oesophageal temperature and has much to recommend it in terms of convenience, safety and postoperative patient comfort.

Liposuction With “Sonic Sculpture”: Six Years’ Experience With More Than 600 Patients

I have used ultrasound-assisted lipoplasty for more than 6 years on more than 600 patients, using first the Ultravac Series 3 and now the Surgitron Series 2000 and 3000 prototypes. Ultrasonic energy for liquefaction of body fat evolved from the use of such energy in phacoemulsification of cataracts. I have all but completely abandoned conventional liposuction techniques in favor of ultrasound-assisted lipoplasty for the reduction of excess fatty deposits in both minimal and large volume cases. This clinical review outlines the method of outpatient treatment of 600 cases of trunk ultrasound-assisted lipoplasty, with or without thigh reduction, 174 chin and neck suctions, 12 upper arm sculptings, 30 breast reductions with soft tissue excision, 17 calf reductions, and 40 gynecomastia reductions, most of which involved soft tissue subareolar resection. Many of the patients underwent multiple area reductions simultaneously. Advantages of this technology to both patient and surgeon, include greater postoperative patient comfort, better refinement in body sculpting, diminished blood loss, an opportunity to provide the larger patient lipoplasty, greater speed of execution in liposuction, and, finally, reduced physical effort by the surgeon. A low complication rate (3% overall), mainly small surface irregularities, lends more to the attractiveness of this modality as being worthy of further study for widespread surgical use.

Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH)

We propose a novel technique for laparoscopic treatment of perforated gastroduodenal ulcers. The principle of this procedure involves the closure of the perforated ulcer using the ligamentum teres hepatis (LTH). The LTH is cut near its umbilical end and then dissected up to the site of its hepatic insertion. The umbilical extremity of LTH is grasped with a Dormia noose passed through the ulcerated perforation via a gastroscope. Using the noose, the LTH is pulled through the ulcerated perforation until its volume fits and completely closes the perforation. This laparoscopic technique was performed in 15 patients (12 M, 3 F) with anterior perforated duodenal ulcer revealed within the previous 6 h. The procedure could not be performed in three cases: diameter of the perforation exceeding 1.5 cm (n = 1), general purulent peritonitis (n = 2). In the other 12 cases, closure of the ulcerated perforation with the LTH was realized without technical difficulty. The postoperative course was uncomplicated. The posttreatment comfort was excellent; the mean period of hospitalization was 10 days (range, 8-14 days). An endoscopic examination carried out following 5 weeks of anti-H2 treatment showed that cicatrization of the ulcer was good and that no pyloric stenosis remained. These initial results suggest that laparoscopic treatment of perforated gastroduodenal ulcer using the LTH is a simple procedure which can be performed with general assurance of success in patients whose perforated ulcers have occurred quite recently. As the laparoscopic procedure is less aggressive than a laparotomy, it enhances the postoperative comfort of patients and prevents the risk of parietal complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective Study of Sub-Tenon's versus Retrobulbar Anesthesia for Inpatient and Day-surgery Trabeculectomy

Several retrospective studies have demonstrated the safety and efficacy of sub-Tenon's anesthesia in ocular surgery. This is the first prospective randomized study comparing sub-Tenon's versus retrobulbar anesthesia for glaucoma surgery. Thirty-nine patients undergoing both inpatient and day surgery trabeculectomy were randomized to receive retrobulbar or sub-Tenon's anesthesia. Retrobulbar anesthesia consisted of a 1.5-ml injection of a 1:1 mixture of 2% lidocaine without epinephrine and 0.5% plain bupivacaine with hyaluronidase. Sub-Tenon's anesthesia consisted of 2% lidocaine without epinephrine injected over the superior, medial and lateral recti muscles. Both groups received a van Lint lid block and a standardized sedative. Outcome parameters evaluated included patient demographics, operative complications, intraoperative and postoperative patient comfort, and volume of anesthetic. Seventeen patients were randomized to the retrobulbar group and 22 to the sub-Tenon's group. Patient discomfort was statistically similar between the groups. There was no statistical difference between groups with respect to quantity of sedative received, surgical exposure, eye movements, or operative complications. A retrobulbar hemorrhage, however, developed at the time of retrobulbar anesthesia in one patient, requiring cancellation of surgery. A larger volume of local anesthetic was required in the retrobulbar group versus the sub-Tenon's group (1.8 versus 1.1 ml; P < 0.01). Patients receiving retrobulbar injections were more likely to require additional anesthesia (P < 0.01) and postoperative analgesics (P < 0.05) compared with patients undergoing sub-Tenon's injection. There was no significant difference between the groups with respect to age, sex, or operated eye. Sub-Tenon's anesthesia is safe and effective for patients undergoing either inpatient or day-surgery trabeculectomies, and it requires less local anesthetic than retrobulbar anesthesia.