Two-quadrant sub-Tenon's anaesthesia using 10 ml of a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine with 150 IU hyaluronidase seems to be more effective than a single-quadrant technique at reducing intraoperative and postoperative pain during vitrectomy.
Summary
In a double blind, randomised controlled trial, we examined the effect of warming local anaesthetic solutions on the pain experienced by patients undergoing a sub‐Tenon's block for cataract surgery. In all, 140 patients were randomly allocated to receive either local anaesthetic stored at room temperature (control group) or local anaesthetic warmed to 37 °C (study group). Pain scores were assessed using a verbal analogue scale from 0 to 10. There was no significant difference in pain scores between the two groups. We conclude that the practice of warming local anaesthetic prior to performing a sub‐Tenon's block does not significantly reduce the amount of pain experienced by patients.
Intro
Ophthalmic surgery ranks among the commonest procedures performed worldwide. This review considers the range of anaesthetic techniques available to the modern ophthalmic anaesthetist, and practical considerations to evaluate in different circumstances. There is a brief summary of the main issues pertaining to the common ophthalmic subspecialties and operations.
Sources of data
Pubmed.
Areas of agreement
We present a view of contemporary ophthalmic anaesthetic practice as we see it, both from current UK clinical experience, and the available published evidence.
Areas of controversy
There is an ongoing debate about the safety of sharp needle blocks (SNBs) compared to subtenons and topical techniques, but SNBs still have a role to play, both in specific cases, and in circumstances where resources are limited.
Growing points
It remains a challenge to provide safe, cost effective anaesthesia to a growing patient base with ever increasing demands and medical comorbidities. There is a continuing trend towards replacing general with local anaesthesia where possible.
Research
Research in ophthalmic anaesthesia, as in so many areas, has been plagued by heterogeneity and small studies. A coordinated, large scale, multicentred approach to research questions in future would help to guide best practice with more certainty.
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