Peribulbar anesthesia and sub‐Tenon injection for vitreoretinal surgery: 300 cases

Calenda, Emile; Ollé, Priscille; Muraine, M.

doi:10.1034/j.1600-0420.2000.078002196.x

Cited by 38 publications

(19 citation statements)

References 12 publications

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“…However, more recent published data show strong evidence of the effectiveness of local anaesthesia in intraoperative comfort and in controlling postoperative pain. 7,9,[18][19][20] Isernhagen's results were also skewed with 58% of eyes having previous retinal surgery.…”

Section: Discussionmentioning

confidence: 95%

“…There are several other reports that support our findings of reduced pain and patient satisfaction for local anaesthesia. 7,9,[18][19][20] In September 2004, the in patient facility was withdrawn from the dedicated eye unit at King Edward VII Hospital, Windsor. This study was designed to identify the intervention necessary during in-patient stay and the feasibility of providing day-case surgery.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of day-case vitreoretinal surgery

Desai

Rubinstein

Reginald

et al. 2006

Eye

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Purpose The indications for vitreoretinal (VR) surgery are increasing as equipment and techniques available improve. In order to decrease demand on limited health resources, day-case surgery would be beneficial in many cases. This study combines a retrospective and prospective arm to examine the feasibility and safety of routine day-case VR surgery. Methods One hundred consecutive patients (50 retrospective and 50 prospective) undergoing VR surgery within the Royal Berkshire NHS trust were included. The retrospective arm aimed to identify the frequency and type of acute ophthalmic or medical intervention during postop overnight stay and the results were used to alter management in the prospective group. The prospective group consisted of patients undergoing a mixture of overnight stay and day-case surgery. All patients in the prospective group had routine subtenon marcaine anaesthesia together with prophylactic pre-operative intravenous acetazolamide. Patients deemed fit postoperatively were offered overnight ward discharge, with obligatory next-day review. Results In the retrospective arm, 56% required oral nonsteroidal analgesia on the day of surgery and one patient required narcotic analgesia. Twenty-two per cent patients required intraocular pressure (IOP) control on the day of surgery and one patient required medical intervention in the form of urinary catheterisation. Nineteen patients required intervention on next-day review. In the prospective arm, 86% preferred day case and were suitable, 6% were suitable for day-case but preferred overnight stay and 8% were deemed not fit for discharge. No patient required narcotic analgesics. No patient discharged returned as a casualty overnight. Only one patient required topical beta-blocker for the control of IOP on next-day review.Conclusions These data suggest that many patients who are hospitalised overnight for VR surgery could be safely treated as day cases. Such a shift in the pattern of care for VR surgery could provide a significant improvement in health-care efficiency and minimise patient inconvenience.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Feasibility of day-case vitreoretinal surgery

Desai

Rubinstein

Reginald

et al. 2006

Eye

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“…The reluctance to use local anaesthesia alone for vitreoretinal surgery may stem from the longer, more unpredictable and uncomfortable nature of such surgery [4]. Surgical dissatisfaction because of insufficient akinesia resulting from partial blockade [5] and patient discomfort during prolonged surgery involving scleral buckling are further limitations to the use of local anaesthesia alone. The combination of general anaesthesia and peribulbar anaesthesia may reduce these drawbacks [6].…”

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confidence: 99%

The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery

Ghali¹,

Btarny

2010

Anaesthesia

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SummaryThe purpose of this study was to evaluate peri-operative outcome after vitreoretinal surgery when peribulbar anaesthesia is combined with general anaesthesia. Sixty adult patients undergoing elective primary retinal detachment surgery with scleral buckling or an encircling procedure received either peribulbar anaesthesia in conjunction with general anaesthesia or general anaesthesia alone. For peribulbar anaesthesia a single percutaneous injection of 5-7 ml of local anaesthetic solution (0.75% ropivacaine with hyaluronidase 15 iu.ml )1 ) was used. The incidence of intraoperative oculocardiac reflex and surgical bleeding interfering with the surgical field, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In the block group there was a lower incidence of oculocardiac reflex and surgical bleeding intraoperatively. Patients in the block group also had better postoperative analgesia and a lower incidence of postoperative nausea and vomiting compared with the group without a block. The use of peribulbar anaesthesia in conjunction with general anesthesia was superior to general anaesthesia alone for vitreoretinal surgery with scleral buckling.

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“…A variety of methods have been described. [8][9][10][11][12][13][14][15][16][17] Advantages of LA over GA include more rapid patient recovery; however also there are some procedures where having an awake patient who is able to cooperate and follow instructions can be helpful. In PRP treatment, the retention of motility such that the patient is able to move the eye around on request leads to an easier view of the peripheral retina with less need for indenting, less conjunctival trauma, and more complete peripheral treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Local anaesthesia has replaced general anaesthesia as it is well tolerated by patients and allows rapid postoperative recovery. [8][9][10][11][12][13][14][15][16] Several local anaesthetic techniques for VR have been used and we have previously reported results using the anterior intraconal technique first described by Wong et al 17 Several authors comment that a potential problem with this technique was that total akinesia was difficult to achieve, which may make perioperative complications more likely. In our hands, however, we found that the intraconal block gave an akinetic block in the majority of cases.…”

Section: Introductionmentioning

confidence: 99%

Kinetic anaesthesia for laser surgery

Cuthbertson¹,

Newsom²,

Wainwright

2004

Eye

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Purpose Local anaesthetic is widely used in ophthalmic surgery and more recently in vitreoretinal surgery. Akinesia is a useful effect of local anaesthetic blocks, but there are situations where some residual globe movements are of benefit. We looked to see whether reducing the volume of anaesthetic solution used in a block could retain some kinesia while achieving good analgesia. Methods We compared two groups of patients undergoing panretinal photocoagulation (PRP) with an indirect laser. The control group received 5 ml of anaesthetic solution in a single injection by a standard intraconal technique; a second group received a lower volume of solution by the same technique. We recorded the adequacy of anaesthesia and the amount of residual kinesia for the two groups. Differences between groups were analysed using the Student's t-test and v 2 tests. Results The low-volume group received an average of 2.8 ml, compared to 5 ml in the control group. There was no significant difference in the adequacy of analgesia achieved, however 16/18 (89%: 95% confidence intervals (CI) ¼ 81.5-96.3%) of the low-volume group had good perioperative kinesia compared to just 3/21 (14%: 95% CI ¼ 6.6-21.9%) of the controls (Po0.001). Conclusions We have shown that low-volume intraconal blocks retain some perioperative kinesia without compromising their analgesic effect.

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Peribulbar anesthesia and sub‐Tenon injection for vitreoretinal surgery: 300 cases

Cited by 38 publications

References 12 publications

Feasibility of day-case vitreoretinal surgery

Feasibility of day-case vitreoretinal surgery

The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery

Kinetic anaesthesia for laser surgery

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