Abstract
Purpose
Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA). We reanalysed the anaesthetic practice for vitreoretinal surgery in our unit over a 19-month period.
Methods
A total of 1003 patients undergoing vitreoretinal surgery between August 2000 and February 2002 were studied. Type of surgery, patient pain score to anaesthesia and surgery, need for sedation and incidence of complications related to the local anaesthetic were recorded. Comparisons were made between this case series and previous data from our unit.
Results
In total, 920/1003 (91.7%) patients had LA. Total operations comprised 418 vitrectomies, 518 retinopexies with or without vitrectomy and 67 buckling procedures. More patients under the age of 35 years had LA than previously (60.2 vs35.7%, P<0.001). In 920/920 (100%) of cases, LA was administered via intraconal injection, compared to 164/1221 (13.4%) of procedures previously. Significantly more patients under the age of 35 years required sedation (35.9%) than did older patients (19.2%). Overall, use of sedation was significantly increased since our previous study (20.2 vs7.8%). Anaesthesia and surgery were well tolerated by patients. There were no cases of orbital haemorrhage or ocular perforation. Complications included bradycardia requiring atropine 1/920 (0.1%) and chemosis 88/920 (9.6%).
Conclusions
LA is well tolerated and effective even in younger patients. Sedation may well be required in younger patients and for procedures involving scleral buckling. The main indication for GA was patient preference. Despite this, such patients accounted for only 5.2% of the total.
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References
Newsom RS, Wainwright AC, Canning CR . Local anaesthesia for 1221 vitreoretinal procedures. Br J Ophthalmol 2001; 85: 225–227.
Rao GP, Wong D, Groenewald C, McGalliard JN, Jones A, Ridges PJ . Local anaesthesia for vitreoretinal surgery: a case–control study of 200 cases. Eye 1998; 12 (Part 3a): 407–411.
Sharma T, Gopal L, Parikh S, Shanmugam MP, Badrinath SS, Mukesh BN . Parabulbar anesthesia for primary vitreoretinal surgery. Ophthalmology 1997; 104: 425–428.
Kristin N, Schonfeld CL, Bechmann M, Bengisu M, Ludwig K, Scheider A et al. Vitreoretinal surgery: pre-emptive analgesia. Br J Ophthalmol 2001; 85: 1328–1331.
Demediuk OM, Dhaliwal RS, Papworth DP, Devenyi RG, Wong DT . A comparison of peribulbar and retrobulbar anesthesia for vitreoretinal surgical procedures. Arch Ophthalmol 1995; 113: 908–913.
Kwok AK, Van Newkirk MR, Lam DS, Fan DS . Sub-Tenon's anesthesia in vitreoretinal surgery: a needleless technique. Retina 1999; 19: 291–296.
Stevens JD, Franks WA, Orr G, Leaver PK, Cooling RJ . Four-quadrant local anaesthesia technique for vitreoretinal surgery. Eye 1992; 6 (Part 6): 583–586.
Jonas JB, Budde WM, Dinkel M, Hemmerling TM . Indwelling temporary retrobulbar catheter for long-lasting titratable local anesthesia. Arch Ophthalmol 2000; 118: 996–1000.
Jonas JB, Hemmerling TM, Budde WM, Dinkel M . Postoperative analgesia by reinjections of local anesthetic through an indwelling retrobulbar catheter. Am J Ophthalmol 2000; 129: 54–58.
Newsom R, Luff A, Wainwright C, Canning C . UK survey of attitudes to local anaesthesia for vitreoretinal surgery. Eye 2001; 15: 708–711.
Eke T, Thompson JR . The National Survey of Local Anaesthesia for Ocular Surgery. I. Survey methodology and current practice. Eye 1999; 13 (Part 2): 189–195.
Waller SG, Taboada J, O'Connor P . Retrobulbar anesthesia risk. Do sharp needles really perforate the eye more easily than blunt needles? Ophthalmology 1993; 100: 506–510.
National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes. Eye 2002; 1 (6): 771–777.
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Costen, M., Newsom, R., Wainwright, A. et al. Expanding role of local anaesthesia in vitreoretinal surgery. Eye 19, 755–761 (2005). https://doi.org/10.1038/sj.eye.6701640
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DOI: https://doi.org/10.1038/sj.eye.6701640
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