Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: a randomized trial

Autor: Ingrid U. Scott, João Abrão, Rodrigo Jorge, Daniel S. Ribeiro, J Ribeiro
Rok vydání: 2020
Předmět:
Male
Lidocaine
genetic structures
medicine.medical_treatment
Vitrectomy
Topical Anesthesia
Interquartile range
Anesthesiology
Medicine and Health Sciences
Anesthesia
Ropivacaine
Prospective Studies
Anesthetics
Local
Pain Measurement
Multidisciplinary
Pharmaceutics
Ophthalmic Procedures
Drugs
Cataract Surgery
Middle Aged
PROCEDIMENTOS CIRÚRGICOS OFTALMOLÓGICOS
medicine.anatomical_structure
Medicine
Female
Anatomy
Injections
Intraocular
medicine.drug
Research Article
Pars plana
Science
Perforation (oil well)
Pain
Surgical and Invasive Medical Procedures
Injections
Signs and Symptoms
Drug Therapy
Ocular System
medicine
Pain Management
Humans
Anesthetics
Aged
Pharmacology
business.industry
Biology and Life Sciences
Phacoemulsification
eye diseases
Intravenous anesthesia
Eyes
Local and Regional Anesthesia
Clinical Medicine
business
Head
Anesthesia
Local
Zdroj: Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual)
Universidade de São Paulo (USP)
instacron:USP
PLoS ONE, Vol 15, Iss 8, p e0236624 (2020)
PLoS ONE
Popis: PurposeTo compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia.MethodsProspective, single-center, randomized study. Patients scheduled for PPV for macular hole (MH) or epiretinal membrane (ERM) at the Retina and Vitreous Section of the Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo were randomly assigned to one of two groups in a 1:1 allocation ratio. Patients assigned to Group ST received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2-4 ml of 1% ropivacaine. Patients assigned to PB received peribulbar anesthesia with 4-6 ml of 1% ropivacaine. After PPV, patients in both groups were asked to rate the level of pain they felt during the entire procedure (including anesthesia administration and PPV) by pointing at a 0-100 Visual Analogue Pain Scale (VAS). Data regarding demographics, patient characteristics and surgical features were also collected.ResultsFifty-four patients were enrolled in the study (26 in Group ST and 28 in Group PB). Baseline characteristics, including age, gender, and presence of comorbidities, were similar in both groups. The surgery performed was PPV alone in 10 and 14 patients in the ST and PB groups, respectively, and combined phacoemulsification and PPV in 16 and 14 patients in the ST and PB groups, respectively (p = 0.39, Pearson). Surgery duration (mean ± SD minutes) was similar in the two groups (62 ± 12 for ST and 70 ± 20 for PB, p = 0.09, t-Test). No patients needed supplemental topical or intravenous anesthesia during surgery. No sight- or life-threatening complication was observed in either group. VAS score was significantly lower in the ST compared to the PB group (median (interquartile range) was 1 (2.25-0) in the ST group compared to 11.5 (29.75-5) in the PB group, p< 0.0001, Wilcoxon).ConclusionIn this study of patients who underwent PPV for MH or ERM, topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia. Compared to peribulbar anesthesia which is administered with a sharp needle, sub-Tenon anesthesia administered with a blunt cannula may be associated with a reduced risk of such adverse events as globe perforation, retrobulbar hemorrhage, and inadvertent injection of anesthesia into the optic nerve sheath.
Databáze: OpenAIRE
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