Anesthesia for phacotrabeculectomy

New anesthetic approach in glaucoma surgery: "Underbleb" subtenonian anesthesia and its influence in medium term outcome

PURPOSE

To present a new anterior subtenonian anesthesia approach in the area of the future filtration bleb and its influence on medium term surgical success.

MATERIAL AND METHODS

Retrospective study of 97 surgeries, deep sclerectomy (DE) or phaco-deep sclerectomy (PHACO-DS), were performed in patients with open angle glaucoma (OAG) comparing our modified "underbleb" subtenonian anesthesia (USA) (n=58) versus a control group under peribulbar anesthesia (PA) (n=38). Main outcomes were intraocular pressure (IOP), number of antiglaucomatous drugs and total and qualificated success, compared during 1, 3, 6, 12, 18 and 24 months follow up after glaucoma surgery.

RESULTS

Both groups were comparable in terms of age, gender, surgical technique, number of antiglaucoma drugs and preoperative IOP. The IOP in the USA group decreased as in PA control group without statistical significant differences except at 24 months, where the IOP was 2mm lower (14.83 ± 2.87 vs. 17.61 ± 4.27 (P=.009). This happened for both, DS and PHACO-DS surgeries. The number of postoperative drugs was lower at 3, 6, and 18 months but without statistically significant diferences. Total success rate at 24 months was higher in the USA group respect AP control group (62.5% vs. 51.6) as well as partial success (100% vs. 71%).

CONCLUSION

Our new USA anesthetic technique does not have a negative impact in DS medium-term surgical success, even it could contribute to a longer-term improvement.

Prospective study of cooperation and satisfaction in glaucoma surgery under sub-Tenon's anesthesia

OBJECTIVES

To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery.

MATERIAL AND METHODS

Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain).

RESULTS

The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30 min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was "fairly or very satisfied" in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=.027) in trabeculectomy than in deep sclerectomy patients.

CONCLUSIONS

The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients.