Preventive Analgesia, Hemodynamic Stability, and Pain in Vitreoretinal Surgery

Abstract

Background and Objectives: Although vitreoretinal surgery (VRS) is most commonly performed under regional anaesthesia (RA), in patients who might be unable to cooperate during prolonged procedures, general anaesthesia (GA) with intraprocedural use of opioid analgesics (OA) might be worth considering. It seems that the surgical pleth index (SPI) can be used to optimise the intraprocedural titration of OA, which improves haemodynamic stability. Preventive analgesia (PA) is combined with GA to minimise intraprocedural OA administration. Materials and Methods: We evaluated the benefit of PA combined with GA using SPI-guided fentanyl (FNT) administration on the incidences of PIPP (postprocedural intolerable pain perception) and haemodynamic instability in patients undergoing VRS (p < 0.05). We randomly assigned 176 patients undergoing VRS to receive GA with SPI-guided FNT administration alone (GA group) or with preventive topical 2% proparacaine (topical anaesthesia (TA) group), a preprocedural peribulbar block (PBB) using 0.5% bupivacaine with 2% lidocaine (PBB group), or a preprocedural intravenous infusion of 1.0 g of metamizole (M group) or 1.0 g of paracetamol (P group). Results: Preventive PBB reduced the intraprocedural FNT requirement without influencing periprocedural outcomes (p < 0.05). Intraprocedural SPI-guided FNT administration during GA resulted in PIPP in 13.5% of patients undergoing VRS and blunted the periprocedural effects of preventive intravenous and regional analgesia with respect to PIPP and haemodynamic instability. Conclusions: SPI-guided FNT administration during GA eliminated the benefits of preventive analgesia in the PBB, TA, M, and P groups following VRS.

Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

“…Patients were randomly allocated into five groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine (alcaine, propacaine hydrochloride ophthalmic solution USP 0.5%, 15 mL, Sandoz a Novartis Company, Warszawa, Poland) 15 min before induction of GA; (3) Group PBB, including patients who received PBB using a mixture of 3.5 mL each of 2% lignocaine (Lignocainum hydrochloricum WZF 2% solution, 20 mg/mL, 2 mL, Polfa Warszawa S.A, Warszawa, Poland), and 0.5% bupivacaine (Bupivacainum hydrochloricum WZF 0.5%, 5 mg/mL, 10 mL, Polfa Warszawa S.A, Warsaw, Poland) with Hamilton’s technique, 1 min before induction of GA [ 25 ]; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole (Pyralgin 0.5 g/mL, 5 mL solution; Polpharma SA, Starogard Gdański, Poland) in 100 mL of saline solution intravenously 30 min before arrival at operating room; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen (Paracetamol Kabi 10 mg/mL, solution 100 mL; Fresenius Kabi, Kutno, Poland) in 100 mL of saline solution intravenously, 30 min before arrival at the operating room [ 24 ].…”

“…After loss of consciousness, rocuronium was administered at a standard intravenous dose of 0.6 mg/kg (Esmeron, rocuronium bromide, 10 mg/mL, 5 mL, Fresenius Kabi, Kutno, Poland) for neuromuscular blockade, followed by the placement of an LMA. The exhaled carbon dioxide concentration (EtCO2) level was maintained at 35–37 mmHg after LMA placement and before the commencement of surgery; the sevoflurane concentration was maintained at a level of approximately 35–45 on state entropy (SE) [ 24 ].…”

“…The depth of anesthesia was monitored with entropy EEG (state and response). Intraoperative analgesia was guided by SPI, and neuromuscular blockade was monitored (Carescape B650, Servsystem, Tyczyn, Poland) [ 24 ].…”

“…In our previous work, we evaluated the effect of AoA-guided intraoperative titration of IO using fentanyl (FNT) on the dose of the cumulative IO, hemodynamic stability, as efficacy of postoperative analgesia assessed by SPI and NRS values, and in patients undergoing PPV under GA alone or in combination with different regional or intravenous PA techniques [ 24 ]. The additional analysis of secondary outcomes aimed to analyze the rate of postoperative nausea and vomiting (PONV), oculo-cardiac reflex (OCR), and oculo-emetic reflex (OER) as perioperative adverse events.…”

Adequacy of Anesthesia Guidance for Colonoscopy Procedures

“…The most widely used are the Bispectral Index (BIS) and a State and Response Entropy EEG (SE & RE EEG) [ 17 , 18 , 19 , 20 ]. In recent years, the Surgical Pleth Index (SPI), a new method of objective assessment of nociception/antinociception balance, has been added to RE and SE order to serve together as the Adequacy of Anesthesia (AoA) concept, a new tool (SPI; GE Healthcare, Helsinki, Finland) that, with different success rates, has been proven useful to guide adequate anesthetic dosages for hypnosis as well as opioids for analgesia [ 21 , 22 , 23 ], aiming to reduce the occurrence of unwelcome adverse events [ 24 , 25 , 26 ].…”