Patients’ Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy

Abstract

Purpose. The purpose of this study was to evaluate the correlation between pain associated with retrobulbar block and anxiety levels before the injection. Methods. This prospective observational, noninterventional study included consecutive patients who received a retrobulbar block by a single surgeon prior to undergoing 25G PPV at the Department of Ophthalmology, Rambam Health Care Campus, between April 2016 and August 2017. Patients plotted their anxiety levels (scale 0–10) using the visual analogue scale for anxiety (VASA), and immediately after receiving the injection, they plotted their experienced level of pain (scale 0–10) using the visual analogue scale for pain (VAS), with scores ≥7 defined as severe. Results. Overall, 48 eyes of 48 patients aged 68.4 ± 10.3 years were included, of which 62.5% were of male gender. Severe anxiety and pain were experienced by 10.4% and 12.5%, respectively. There was a significant correlation between VASA and VAS scores (r = 0.43, p=0.002) with no other preprocedural parameters demonstrating a significant association with the VAS score. In multivariate analysis, the VASA score was the only factor that was significant (p=0.01), and a patient with a severe VASA score was 20 times more likely of experiencing severe pain (p=0.006). The ROC curve analysis revealed an area under the curve of 0.89 (p<0.001), and a VASA score >4 demonstrated a sensitivity of 83.3% and a specificity of 73.8% in predicting severe pain. Conclusions. Approximately 10% of patients experience severe anxiety and pain during retrobulbar blocks. Considering the importance of compliance, reducing anxiety and premedication may be considered, particularly in high-risk patients (VASA score > 4).

Globe penetration during loco-regional anesthesia: prevalence and review of cases

“…This type of anesthesia includes different sub-types, such as topical anesthesia [13][14][15] , subconjunctival anesthesia [16][17][18] , retrobulbar anesthesia, peribulbar anesthesia, sub-Tenon's anesthesia [9,[19][20] , medial canthus epiescleral anesthesia [21] and facial nerve block. Topical anesthesia has become a common form of anesthesia; however, it requires that the surgery is performed quickly and efficiently to minimize stress on the patients [22] , patient cooperation [23] , experienced surgeon [10] and it doesn't provide the same level of pain relief as peribulbar anesteshia [24][25] . We still prefer loco-regional anesthesia not only for posterior segment or glaucoma surgery but also because it is the preferred method for anterior segment surgery.…”

“…Our estimated prevalence of 0.024% falls within the range described. Described risk factors for globe penetration include posterior staphyloma [34] , long axial length [11] , inexperienced personnel [35] and uncooperative patients [23] . In our study, two eyes had myopia.…”

Prophylactic effect of brimonidine to minimize the incidence of subconjunctival hemorrhage in the early postoperative period after 23G pars plana vitrectomy

“…2 The level of anxiety in patients requiring vitreoretinal surgery is often high due to the severity of their pathology and the concern about surgery itself. 15 Vitrectomy surgery with the use of microcannulas has shortened the duration of the postoperative period, avoiding the need to use stitches, which has also reduced postoperative discomfort. Postoperative subconjunctival hemorrhage is very striking and is usually a cause of concern in patients and family members.…”

Prophylactic Effect of Brimonidine To Minimize The Incidence of Subconjunctival Hemorrhage after 23G Pars Plana Vitrectomy

“…The level of anxiety in patients requiring vitreoretinal surgery is often high due to the severity of their pathology and the concern about surgery itself [12]. Vitrectomy surgery with the use of microcannulas has shortened the duration of the postoperative period, avoiding the need to use stitches, which has also reduced postoperative discomfort.…”