Loco-regional anaesthesia for ocular surgery: Anticoagulant and antiplatelet drugs

Mather, Stephen J.; Kong, K.-L.; Vohra, S. B.

doi:10.1016/j.cacc.2010.02.011

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…Two prior case reports suggested that myelinated axons were lost in glaucoma. 2,3 We report a case of advance glaucoma where there is preservation of myelinated nerve fibres.…”

Section: Michael Tsatsos MD Mrcophth Craig Am Burnett Md Mrcophth Dmentioning

confidence: 99%

“…There is some evidence that peribulbar anaesthesia may have a higher risk of inducing retrobulbar haemorrhage when compared with sub-Tenon's anaesthesia, especially in warfarinized patients. 2,3 An alternative approach would be to use subconjunctival anaesthesia for cyclodiode laser. 4 Proponents of this technique recommend a significant delay between LA and diode application, making it unsuitable for our practice.…”

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confidence: 99%

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Local anaesthesia for trans‐scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub‐Tenon's and peribulbar anaesthesia

Tsatsos

Burnett

Broadway

et al. 2011

Clinical Exper Ophthalmology

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Local anaesthesia for trans-scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub-Tenon's and peribulbar anaesthesia This was a prospective assessment of routine practice for two glaucoma specialists at the same institution. One specialist routinely used a small volume posterior sub-Tenon's LA (2 mL of 2% lidocaine via a Stevens type long metal cannula); the other used a one-site peribulbar approach (6 mL of 2% lidocaine via infero-temporal approach). Laser settings and technique were the same for both specialists. The Iris Medical OcuLight SLx laser (810 nm) was used. Standard technique was to apply 40 laser shots of 1500 mW power and 1500 ms duration, using the G-probe. The globe was transilluminated in order to identify the ciliary body, prior to commencing laser treatment. Treatment was delivered to 360°, except for the 3 o'clock and 9 o'clock positions (long ciliary nerves and vessels) and sites of previous glaucoma surgery.We looked at patient discomfort scores for LA and for the laser itself. Patients were asked to rate their discomfort using a 0-10 scale (0 = no discomfort, 10 = worst pain imaginable). Chemosis and/or subconjunctival haemorrhage in the perilimbal area could interfere with laser application, so this was also recorded on a scale of 0-12 clock hours. At the end of the procedure, we assessed eye movement and lid closure. We asked all patients if they would be happy to have the same LA again, if the procedure needed to be repeated.Results are summarized in the table. Thirty-three patients had peribulbar LA, and 50 had sub-Tenon's LA. Pain scores for both LA techniques were low, with mean pain score in the order of 3/10 for both peribulbar and sub-Tenon's LA. Mean score for the laser itself was around 1/10 for each LA technique. Other 'patient acceptability' criteria appear in the table.Conditions for applying the laser were assessed (Table 1). There was a low rate of chemosis and haemorrhage in the perilimbal area. There were no complications that could be ascribed to LA technique.Our study shows that sub-Tenon's LA and peribulbar LA can both provide adequate anaesthesia for cyclodiode laser to the ciliary body.Pain scores were low for both groups. Peribulbar anaesthesia was associated with slightly lower pain scores, both for the LA and for laser application. However, more patients in the peribulbar group were given a 'top-up' LA (36% vs. 4%), and more patients in the peribulbar group stated that they would not wish to have the same LA/procedure again (18% vs. 0%). A prospective

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“…Two prior case reports suggested that myelinated axons were lost in glaucoma. 2,3 We report a case of advance glaucoma where there is preservation of myelinated nerve fibres.…”

Section: Michael Tsatsos MD Mrcophth Craig Am Burnett Md Mrcophth Dmentioning

confidence: 99%

mentioning

confidence: 99%

Local anaesthesia for trans‐scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub‐Tenon's and peribulbar anaesthesia

Tsatsos

Burnett

Broadway

et al. 2011

Clinical Exper Ophthalmology

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“…For non-cataract ocular and orbital surgery (intermediate to high risk of haemorrhage), there should be discussions among the anaesthesiologist, surgeon and patient regarding the risks and benefits of continuing/discontinuing anticoagulant and antiplatelet drugs and to agree to an acceptable approach such as bridging therapy in the interest of total patient care. [910]…”

Section: Pre-operative Systemic Assessment and Preparationmentioning

confidence: 99%

Ophthalmic regional anaesthesia: A review and update

Jaichandran

2013

Indian J Anaesth

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Local anaesthetic techniques are increasingly popular for ophthalmic surgery. It is now being provided mainly by anaesthesiologists and varies from an akinetic injection technique to a non-akinetic topical technique. Each technique has its own risk/benefit profile, and proven to be highly successful if performed correctly. The choice of the technique should be individualized based upon specific needs of the patient, the nature and extent of eye surgery, and the anaesthesiologist's and surgeon's preferences and skill. This review article attempts to outline the orbital anatomy, discuss the commonly used agents, current method of pre-operative preparation, available clinical techniques and their inherent complications.

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“…Some studies [ 2 , 5 ] have reported a higher incidence of subconjunctival hemorrhage in patients using antithrombotics when undergoing ophthalmic regional anesthesia. Reduction of this risk of hemorrhage can sometimes be achieved with topical anesthesia [ 6 ], although for some ocular procedures, this technique might not be an option [ 7 ]. Considering that it is now rare for general anesthesia to be used during ophthalmic surgery [ 1 ], many patients on antithrombotics who have ophthalmic surgeries undergo needle-based regional anesthesia [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previous reviews evaluating hemorrhagic complications with respect to ophthalmic surgery have suggested that it is safe to continue antithrombotic therapy before facetectomy and vitrectomy [ 1 , 7 ]. Assessing patients undergoing 25-gauge vitrectomy, Mason et al [ 13 ] found no difference in rates of surgical hemorrhagic complications between those using clopidogrel or warfarin and those not using either.…”

Section: Introductionmentioning

confidence: 99%

Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review

et al. 2016

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BackgroundPatients undergoing ophthalmic surgery are usually elderly and, due to systemic disease, may be on long-term therapy, such as antithrombotic agents. Rates of hemorrhagic complications associated with invasive procedures may be increased by the use of anticoagulants and antiplatelet agents.ObjectiveTo compare the incidence of hemorrhagic complications in patients undergoing needle-based ophthalmic regional anesthesia between patients on antithrombotic therapy and those not on such therapy.MethodsA systematic review was conducted by two independent reviewers based on searches of Cochrane, LILACS, PubMed, Scopus, Web of Science, and the “gray” literature (Google Scholar). The end search date was May 8, 2015, across all databases.ResultsFive studies met the eligibility criteria. In three studies, individual risk of bias was low, and in two of them, moderate. In all studies, no differences regarding mild to moderate incidence of hemorrhagic complications were found between patients using antithrombotics (aspirin, clopidogrel, and warfarin) and those not using them. Rates of severe hemorrhagic complication were very low (0.04%) in both groups, supporting the safety of needle blocks, even in patients using antithrombotics. High heterogeneity across studies prevented meta-analysis. Limitations to these results include low statistical power in three experimental studies and a large 95% confidence interval in the two retrospective cohorts.ConclusionIn this review, none of the selected studies showed significant bleeding related to needle-based ophthalmic regional anesthesia in association with the use of aspirin, clopidogrel, or vitamin K inhibitors. Since the available data is not powerful enough to provide a reliable evaluation of the true effect of antithrombotics in this setting, new studies to address these limitations are necessary.

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Loco-regional anaesthesia for ocular surgery: Anticoagulant and antiplatelet drugs

Cited by 7 publications

References 34 publications

Local anaesthesia for trans‐scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub‐Tenon's and peribulbar anaesthesia

Local anaesthesia for trans‐scleral cyclodiode laser procedures: surgeon and patient satisfaction with sub‐Tenon's and peribulbar anaesthesia

Ophthalmic regional anaesthesia: A review and update

Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review

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