Preemptive Analgesia With Ropivacaine for Pars Plana Vitrectomy

Schönfeld, Carl‐Ludwig; Hierneis, Sonya

doi:10.1097/iae.0b013e318232c34c

Cited by 15 publications

(6 citation statements)

References 19 publications

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“…Two review authors (AL and SS) independently scanned the identified references and excluded references which were not relevant to the scope of this review. We identified six studies which were potentially relevant to the interventional question posed (Celiker 2014;Kristin 2001;Lai 2005;Mahajan 2013;Schönfeld 2012;Tan 2005). On closer review none of these six studies met the selection criteria.…”

Section: Description Of Studiesmentioning

confidence: 99%

Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery

Licina

Sidhu

Xie

et al. 2016

Cochrane Database of Systematic Reviews

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Section: Description Of Studiesmentioning

confidence: 99%

Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery

Licina

Sidhu

Xie

et al. 2016

Cochrane Database of Systematic Reviews

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“…Additionally, various methods of preventive analgesia (PA) for PPV, such as regional techniques [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], and intravenous techniques with preoperative infusion of COX-3 inhibitors (paracetamol, metamizole) [ 21 , 22 ], were shown to provide adequate postoperative analgesia [ 17 ], with a fall in the rate of main adverse events [ 12 , 15 , 23 ] within the mechanism of a reduction in demand for IO.…”

Section: Introductionmentioning

confidence: 99%

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

Pluta

Stasiowski

Lyssek-Boroń

et al. 2021

JCM

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The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 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 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV.

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“…In a study by Fekrat S et al [49], 56% of patients complained of some eye pain after VRS, whereas 48% requested an analgesic within 5 hours after surgery, and 27% percent of patients required OA. Schönfeld CL et al [25] found GA with PBB using 0.75% ropivacaine with 75 IU of hyaluronidase in a volume of 5 ml superior for the prevention of PIPP compared to a volume of 1 or 3 ml. Sixty percent of patients receiving 5 ml experienced no PIPP after one hour of VRS in this study.…”

Section: Postoperative Intolerable Pain Perception (Pipp)mentioning

confidence: 99%

“…Attempts have been made to reduce the dose of intraoperative OA with different techniques of preventive analgesia for VRS. Reduction in the intravenous dose of OA administered intraoperatively with a combination of GA and regional techniques, including preoperative peribulbar block (PBB) [22,23,24,25,26], retrobulbar block (RBB) [27,28], subtendon block [29,30] and topical anaesthesia (TA) [31] have been proven to provide adequate analgesia postoperatively [28], with reduced incidence of OCR [32] and PONV [23,26], despite potential side effects [3].…”

Section: Introductionmentioning

confidence: 99%

Effect of topical or peribulbar analgesia on the incidence of oculocardiac reflex, postoperative pain and postoperative nausea and vomiting following vitreoretinal surgery under surgical pleth index-guided general anaesthesia.

Stasiowski

Pluta

Lyssek-Boroń³

et al. 2019

Preprint

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Background: Despite of the risk of postoperative intolerable pain perception (PIPP), vitreoretinal surgery (VRS) requires general anaesthesia (GA) in selected patients. Intraoperative use of opioid analgesics (OA) during GA carries the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI) optimises the intraoperative titration of OA. Regional anaesthesia techniques are combined with GA to minimize the intraoperative use of OA. We evaluated the benefit of preventive analgesia techniques combined with GA using SPI-guided fentanyl (FNT) administration on the incidence of PONV, oculocardiac reflex (OCR) and PIPP in patients undergoing VRS. Methods: One hundred and five patients undergoing VRS were randomly allocated to receive either GA with SPI-guided fentanyl (FNT) administration alone (GA group) or with preventive topical 2% proparacaine (topical anaesthesia (TA) group) or preoperative peribulbar block (PBB) using 0.5% bupivacaine with 2% lidocaine (PBB group). Fifteen patients were excluded due to problems with postoperative SPI measurement. Results: Preventive PBB resulted in intraoperative reduction in FNT requirement, with no influence on perioperative outcomes. Intraoperative SPI-guided FNT administration during GA resulted in OCR in 7.78%, PONV in 10% and PIPP in 13.5% of patients undergoing VRS. Intraoperative SPI-guided FNT administration blunted the perioperative effect of preventive PBB and TA in terms of the presence of PONV, OCR and PIPP.Conclusions: The utility of SPI-guided FNT administration during GA eliminated benefits of preventive analgesia with PBB and TA following VRS. We recommend using intraoperative SPI-guided FNT administration during GA to reduce the presence of OCR, PONV and PIPP following VRS. Trial registration: The trial was approved and registered by The Ethical Committee of Medical University of Silesia on 29th of September 2015, as well as the project was registered in the Clinical Trial Registry (SilesianMUKOAiIT2, NCT02973581)Key words: vitreoretineal surgery, general anaesthesia, peribulbar block, topical anaesthesia, surgical pleth index.

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Preemptive Analgesia With Ropivacaine for Pars Plana Vitrectomy

Abstract: The study highlights the benefit of the concept of preemptive analgesia in general: the peribulbar injection of 5 mL of 0.75% ropivacaine before surgery provides a substantial benefit in terms of analgesic demand and postoperative discomfort.

Cited by 15 publications

References 19 publications

Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery

Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery

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

Effect of topical or peribulbar analgesia on the incidence of oculocardiac reflex, postoperative pain and postoperative nausea and vomiting following vitreoretinal surgery under surgical pleth index-guided general anaesthesia.

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