Role of anaesthesia in endoscopic and external dacryocystorhinostomy: A meta-analysis of 3282 cases

Abstract

Distal acquired lacrimal obstruction is a common adulthood pathology whose primary treatment is represented by EXT-DCR and END-DCR. When considering their influencing factors, the role of the type of anaesthesia applied during these surgeries has a major role. The aim of this study is to systematically analyse the influence of general and local/regional anaesthesia on the final success rates of EXT-DCR and END-DCR. Primary EXT-DCR and END-DCR articles published later than 2000 with at least 50 single clinician procedures were selected. Exclusion criteria included acute dacryocystitis, tumours, studies focussing on revision surgeries, surgeries with adjunctive procedures, not clearly demarcated surgeons, mixed cohort study of acquired and congenital disorders. This systematic review was conducted in accordance with MOOSE guidelines; where feasible, a meta-analysis of the collected results was conducted. As a result, 11,445 articles were selected of which 2741 were examined after screening, and 16 included after full text review (0.6% of the initial papers). Among all papers included, the number of EXT-DCR was not enough to provide a solid analysis of the effect of anaesthesia; conversely, a significant difference of success rate was noted between local anaesthesia + sedation (85.1%, IC 77.8%–90.4%), and general anaesthesia (90.8%, IC 88.8%–92.4%) in END-DCR ( p = 0.048). In conclusion, END-DCR performed with general anaesthesia should be considered as the solution of choice; however, local anaesthesia, eventually associated with a sedation, can be used as an alternative in selected cases. No meaningful conclusions could be drawn for EXT-DCR, due to the lack of data.

Clinical Profile, Complications and Trends of Ocular Anaesthesia in a Multi-tier Ophthalmology Network in India: An Eight-Year Experience

“…General anaesthesia, although a more costly affair, is indicated in children, if the procedure is timeconsuming or painful, or when local anaesthesia is not possible or due to patient preference [24]. In our study, general anaesthesia was performed more in oculoplastic surgeries, which include external and endoscopic dacryocystorhinostomies, which shows a similar trend as other studies [25,26].…”

Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions

“… 27 , 28 In this regard, a recent meta-analysis that compared END-DCR performed with general and local anesthesia demonstrated that even in cases where powered instruments were used the procedure in local anesthesia provided good functional success rates, that seems to be slightly different to GA ( p = 0.048): however, due to the low number of available publications, no conclusive statements were made. 29 …”

“…On the other hand, local anesthesia, particularly during an endoscopic approach, can cause several adverse events such as perforation of the eyeball, retro-orbital bleeding, damage to the optical nerve, burning of nasal fossa due to peri-procedural application of diathermy during oxygen supply, and discomfort of trickling blood into the throat, which can be occasionally dangerous in patients with altered sensorium secondary to sedation. 29 In addition, in uncollaborative patients operated with END-DCR in local anesthesia, there is the risk of difficult visualization of the surgical field through the endoscopic instrumentations, thus undermining the final outcome. 25 , 26 , 30 …”

“…27,28 In this regard, a recent meta-analysis that compared END-DCR performed with general and local anesthesia demonstrated that even in cases where powered instruments were used the procedure in local anesthesia provided good functional success rates, that seems to be slightly different to GA (p = 0.048): however, due to the low number of available publications, no conclusive statements were made. 29 On the other hand, local anesthesia, particularly during an endoscopic approach, can cause several adverse events such as perforation of the eyeball, retro-orbital bleeding, damage to the optical nerve, burning of nasal fossa due to peri-procedural application of diathermy during oxygen supply, and discomfort of trickling blood into the throat, which can be occasionally dangerous in patients with altered sensorium secondary to sedation. 29 In addition, in uncollaborative patients operated with END-DCR in local anesthesia, there is the risk of difficult visualization of the surgical field through the endoscopic instrumentations, thus undermining the final outcome.…”

“…29 On the other hand, local anesthesia, particularly during an endoscopic approach, can cause several adverse events such as perforation of the eyeball, retro-orbital bleeding, damage to the optical nerve, burning of nasal fossa due to peri-procedural application of diathermy during oxygen supply, and discomfort of trickling blood into the throat, which can be occasionally dangerous in patients with altered sensorium secondary to sedation. 29 In addition, in uncollaborative patients operated with END-DCR in local anesthesia, there is the risk of difficult visualization of the surgical field through the endoscopic instrumentations, thus undermining the final outcome. 25,26,30 For all the above-mentioned reasons, given the wider surgical field through an external approach, which is helpful in uncollaborative subjects, greater historical experience, and no influence on the final success rate, EXT-DCR should be considered the surgical approach of choice in the treatment of DALO in local anesthesia, even if no definitive data has been provided.…”