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Lohmann T, Baumgarten S, Prinz J, Walter P, Koutsonas A. Safety and feasibility of sutureless pars-plana vitrectomy in sub-Tenon anesthesia (SAFE-VISA): a prospective study. Eur J Med Res 2023; 28:472. [PMID: 37899488 PMCID: PMC10614322 DOI: 10.1186/s40001-023-01447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 10/14/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND To determine the safety and feasibility of sutureless pars-plana vitrectomy (ppV) in sub-Tenon anesthesia. METHODS In this prospective study. Pain and anxiety at various times after ppV using a visual analogue scale (VAS) and Wong-Baker-FACES scale as well as visual sensations during surgery were investigated. The surgeon evaluated motility, chemosis, overall feasibility. RESULTS ppV was performed on 67 eyes (33 sub-Tenon anesthesia, 34 general anesthesia). Pain during surgery in sub-Tenon anesthesia was 1.8 ± 2.2 (0.0-8.0), anxiety was 2.3 ± 2.2 (0.0-8.5). There was a moderate correlation between pain and anxiety (R2 = 0.58). Comparing sub-Tenon and general anesthesia no difference in pain perception was found the day after surgery. 27.3% of patients saw details, 21.2% saw colors, 90.1% saw light/motion perception, 3.0% had no light perception. Median chemosis after surgery was 1.0 (IQR = 1.0). Median motility of the eye during surgery was 1.0 (IQR = 1.0), median grade was 1.0 (IQR = 1.0). 24.2% of patients showed subconjunctival hemorrhage during or after surgery. CONCLUSIONS Sutureless pars-plana vitrectomy in sub-Tenon anesthesia was performed safely, with pain and anxiety levels tolerable for the patients and without the necessity for presence of an anesthesiologist. With 88.9% of patients willing to undergo vitreoretinal surgery in sub-Tenon anesthesia again, we recommend it as a standard option. Trial registration This study was approved by the Institutional Ethical Review Board of the RWTH Aachen University (EK 111/19). This study is listed on clinicaltrials.gov (ClinicalTrials.gov identifier: NCT04257188, February 5th 2020).
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Affiliation(s)
- Tibor Lohmann
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Sabine Baumgarten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Antonis Koutsonas
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
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Mohankumar A, Rajan M. Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery. Indian J Ophthalmol 2023; 71:2649-2655. [PMID: 37417102 PMCID: PMC10491076 DOI: 10.4103/ijo.ijo_2515_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 07/08/2023] Open
Abstract
Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.
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Affiliation(s)
- Arthi Mohankumar
- Department of Retina and Vitreous, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India
| | - Mohan Rajan
- Department of Retina and Vitreous, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India
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El Fawal SM, Nofal WH, Sabek EAS, Abdelaal WA. Minimum effective volume of local anesthetic in peribulbar block: does it differ with the eyeball axial length? Braz J Anesthesiol 2021; 71:635-641. [PMID: 34562489 PMCID: PMC9373596 DOI: 10.1016/j.bjane.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Peribulbar Anesthesia (PBA) is a relatively safe method for cataract surgery. The anesthetic volume should be adjusted according to the axial eyeball length. Thus, using Minimum Effective Volume (MEV) of local anesthetic helps avoiding unnecessary volumes, preventing increases in intra-ocular pressure, and producing satisfactory conditions for cataract surgery. This study aims to determine the MEV90 of local anesthetics in relation to eye globe axial length in peribulbar blocks for cataract surgery. Methods Patients scheduled for cataract extraction under local anesthesia were divided according to their axial eyeball length; Group 1 included those with axial length from 22 to 24 mm, Group 2 included patients with axial length from 24.1 to 26 mm. The initial volume used was 7 mL of a solution of bupivacaine 0.5% (3 mL) + lidocaine 2% (3 mL) + hyaluronidase 150 IU (1 mL). The subsequent volumes were dependent on the response of the previous patient, by using a Bias Coin Design (BCD) and Up and Down Method (UDM) for MEV-90 determination. Results The study was concluded with 119 patients. Sixteen patients needed supplemental volume of local anesthetic in Group 1 and thirteen in Group 2. The MEV90 for Group 1 was approximately 5.82 mL (95% CI 5.6 to 5.87 mL) and 5.45 mL for Group 2 (95% CI 5.38 to 5.91 mL). No major complications were noted. There was a negative correlation between the effective volume of LA and eye globe axial length in both groups (p = 0.001). Conclusion The MEV90 of local anesthetics for peribulbar block show a strong and inverse correlation with eye globe axial length. This may help achieving an effective block with minimum complications.
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Affiliation(s)
| | - Walid H Nofal
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Eman A S Sabek
- National Centre of Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt
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Sub-Tenon's anaesthesia for modern eye surgery-clinicians' perspective, 30 years after re-introduction. Eye (Lond) 2021; 35:1295-1304. [PMID: 33536591 DOI: 10.1038/s41433-021-01412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/19/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
Sub-Tenon's block (STB) is a good technique of local anaesthesia for many types of eye surgery. It has a relatively good risk profile, in that sight- and life-threatening complications appear to be extremely rare. STB has gained popularity in the last three decades, with refinements including different types of blunt metal cannula, plastic cannulae and 'incisionless' approaches. Usage of STB varies significantly across the globe. This narrative review documents the historical evolution of STB techniques, anatomical and physiological considerations, its utility and suitability, complications, explores the current practice and possible future applications.
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Evaluation of butorphanol–azaperone–medetomidine (BAM) in captive blesbok immobilization ( Damaliscus pygargus phillipsi ). Vet Anaesth Analg 2018; 45:496-501. [DOI: 10.1016/j.vaa.2017.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 02/20/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022]
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Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10:21-35. [PMID: 27231416 PMCID: PMC4875731 DOI: 10.5005/jp-journals-10008-1198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon's techniques) could potentially damage the optic nerve, and thereby cause "wipe-out" of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author's preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation. How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35.
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Affiliation(s)
- Tom Eke
- Consultant, Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
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Messeha MM, Elhesy AE. Comparison of orbital muscle akinesia caused by rocuronium versus hyaluronidase mixed to the local anesthetic in single injection peribulbar block for cataract surgery. Anesth Essays Res 2015; 9:374-8. [PMID: 26712977 PMCID: PMC4683490 DOI: 10.4103/0259-1162.164649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The aim of this study was to compare orbital muscle akinesia caused by rocuronium versus hyaluronidase when mixed with the local anesthetic in single-injection peribulbar anesthesia (PBA). Patients and Methods: Sixty patients were included in the study and subjected to cataract extraction using phacoemulsification technique with intraocular lens implantation. Group I received peribulbar block with 5 ml mixture of 30 IU/ml hyaluronidase and 2% lidocaine. Group II received peribulbar block with 5 ml mixture of rocuronium 5 mg and 2% lidocaine. The onset and duration of akinesia were assessed; the akinesia score at 2, 5, and 10 min was measured after injection. The need for supplementary injection was also recorded. Results and Conclusion: PBA using a mixture of rocuronium and lidocaine provides optimal globe akinesia and faster establishment of suitable conditions to start eye surgery and shortens the block onset time as compared with the addition of hyaluronidase to lidocaine.
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Affiliation(s)
- Medhat M Messeha
- Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospital, Mansoura, Egypt
| | - Abd-Elmonem Elhesy
- Department of Ophthalmology, Faculty of Medicine, Mansoura Ophthalmology Center, Mansoura University, Mansoura, Egypt
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Yeo G, Gupta A, Ding G, Skerman H, Khatun M, Melsom D. Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial. Adv Orthop 2015; 2015:784329. [PMID: 26587288 PMCID: PMC4637433 DOI: 10.1155/2015/784329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023] Open
Abstract
Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase group receiving both hyaluronidase and local anaesthetic. Pain scores were rated using the visual analogue scale (VAS) by patients immediately after local anaesthetic injection and again immediately after the carpal tunnel release. Results. Preoperative VAS scores, taken after local anaesthetic injection, were greater than postoperative VAS scores. Postoperative VAS scores were significantly lower in the hyaluronidase group and tourniquet times were significantly shorter in the hyaluronidase group. Conclusion. Hyaluronidase addition to local anaesthetic in carpal tunnel release resulted in significant reductions in operative time and pain immediately after operation.
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Affiliation(s)
- G. Yeo
- Royal Brisbane Hospital, Australia
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Johnson MZ, O'Connor TC. Excellent postoperative analgesia with the addition of hyaluronidase to lignocaine for subcostal TAP block used in conjunction with systemic analgesia for laparoscopic cholecystectomy. BMJ Case Rep 2014; 2014:bcr-2013-202911. [PMID: 24510699 DOI: 10.1136/bcr-2013-202911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Subcostal transversus abdominis plane (TAP) blocks provide good postoperative analgesia for laparoscopic cholecystectomies. We hypothesised that adding hyaluronidase may improve the efficacy of this technique by increasing spread of the local anaesthetic (LA). In this case, we performed a bilateral ultrasound-guided subcostal TAP block using lignocaine (40 mL 1%) with hyaluronidase (75 IU/mL) for postoperative analgesia following elective laparoscopic cholecystectomy. It was used in combination with intraoperative morphine, diclofenac and paracetamol. Regular paracetamol was administered postoperatively. We monitored serial serum lignocaine levels and recorded the patient's visual analogue scale (VAS) pain scores postoperatively. We found that the patient experienced excellent analgesia throughout the postoperative period and that the serum lignocaine levels did not exceed the therapeutic range.
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Clarke J. Optimal hyaluronidase dosage. Clin Exp Ophthalmol 2013; 42:299. [PMID: 23844807 DOI: 10.1111/ceo.12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/19/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jon Clarke
- Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia
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Sedghipour M, Mahdavifard A, Fouladi RF, Gharabaghi D, Rahbani M, Amiraslanzadeh G, Afhami M. Hyaluronidase in sub-Tenon's anesthesia for phacoemulsification, a double-blind randomized clinical trial. Int J Ophthalmol 2012; 5:389-92. [PMID: 22773994 DOI: 10.3980/j.issn.2222-3959.2012.03.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/07/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification. METHODS This was a randomized, double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months. Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with (LH), or without (L) addition of hyaluronidase (150IU/mL). Akinesia was assessed 15 minutes after sub-Tenon's injection. Patients and surgeon's satisfaction, as well as the postoperative pain (the visual analogue scale, VAS) were investigated after operation. The contingency tables (including the Chi-square or Fisher's exact tests, when appropriate) and parametric analysis (the independent samples t test) were used for statistical analysis. RESULTS Complete akinesia (33.3% vs 4.8%, P=0.04), as well as the patients (85.7% vs 57.1%, P=0.04) and surgeon's satisfaction (87.5% vs 52.4%, P=0.02) were significantly more frequent in LH than in L group. The mean VAS was significantly lower in the same group (1.90±1.45 vs 3.00±1.55, P=0.04). CONCLUSION Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia, enhances the intra-operative patients and surgeons' satisfaction, and attenuates the postoperative pain.
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Affiliation(s)
- Mohammadreza Sedghipour
- Department of Ophthalmology, Tabriz University of Medical Sciences, Nikookari Eye Hospital, Tabriz, Iran
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AMBULATORY ANAESTHESIA. Br J Anaesth 2012. [DOI: 10.1093/bja/aer472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Villafranca Barba A, Mouslim S, De la Gala García FA, Reyes Fierro A. [Sub-tenon block for ocular globe anesthesia: a review]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:167-173. [PMID: 21534292 DOI: 10.1016/s0034-9356(11)70025-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sub-Tenon anesthesia is an effective, well-tolerated technique for surgery in the anterior or posterior compartments of the eye. The advantages of this block are comparable to those of peribulbar and retrobulbar anesthesia and complications are minimal. Sub-Tenon anesthesia provides better analgesia than akinesia. Most studies suggest that sub-Tenon anesthesia is a good technique to choose, given that potential adverse effects are fewer than for other regional blocks and analgesia and akinesia are superior.
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Affiliation(s)
- A Villafranca Barba
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid.
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Etesse B, Beaudroit L, Deleuze M, Nouvellon E, Ripart J. [Hyaluronidase: Here we go again]. ACTA ACUST UNITED AC 2009; 28:658-65. [PMID: 19577408 DOI: 10.1016/j.annfar.2009.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 05/20/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the benefits and lateral effects of hyaluronidase (H) use in ophthalmologic anaesthesia and to address its unavailability in current practice in France. DATA SOURCES The Medline data bank and the Cochrane database were consulted. The keywords employed separately or in combination were: H, regional anaesthesia, ophthalmologic surgery, local aneasthetics myotoxicity, diplopia. STUDY SELECTION Original articles since 1949 were selected. We also selected isolated clinical cases according to their relevance compared with the existing literature. DATA SYNTHESIS H is a "spreading factor" of animal origin used as an adjuvant in ophthalmic anaesthesia for more than half a century. It allows a moderate better block quality with a slightly quicker onset. It also limits the acute intraocular pressure increase secondary to periocular injection and seems to have a protective effect against local anaesthetics myotoxicity resulting in postoperative strabismus. However, during these last 50 years, numerous studies often ended in divergent results. CONCLUSION H seems to be a useful adjuvant in ophthalmologic anaesthesia in spite of his current unavailability in France. Recombinant H could be the solution in the near future.
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Affiliation(s)
- B Etesse
- Pôle Anesthésie-Douleur-urgences-Réanimation, Groupe Hospitalo-Universitaire Carémeau, 30029 Nîmes cedex 09, France
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Sub-Tenon's anaesthesia: a well tolerated and effective procedure for ophthalmic surgery. Curr Opin Ophthalmol 2009; 20:205-9. [PMID: 19367161 DOI: 10.1097/icu.0b013e328329b6af] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW To report recent advancements with sub-Tenon's anaesthesia for ocular surgery, accentuating the efficacy and safety of this technique. Further clinical implications are reviewed with regard to its technique, indications, benefits, and reported complications. RECENT FINDINGS Sub-Tenon's anaesthesia, a versatile and technically easy procedure to master, has gained popularity with both ophthalmic surgeons and anaesthetists. This block is achieving repute as the block of choice, providing anaesthesia as well as akinesia during ophthalmic surgery. As the technique has further evolved and novel cannulae introduced, increasing complications have been documented. SUMMARY Currently, there is no absolutely well tolerated orbital regional block technique. However, well founded evidence appears to support sub-Tenon's block as a safer option. Sound knowledge of orbital anatomy, pharmacology of anaesthetic agents, and prevention of potential complications are therefore crucial to perform sub-Tenon's block effectively and safely.
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Khan EI, Mustafa J, McAdoo J, Shorten G. Efficacy of sub-Tenon's block using an equal volume of local anaesthetic administered either as a single or as divided doses. A randomised clinical trial. BMC Anesthesiol 2009; 9:2. [PMID: 19323806 PMCID: PMC2666666 DOI: 10.1186/1471-2253-9-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 03/26/2009] [Indexed: 11/10/2022] Open
Abstract
Background Sub-Tenon's anaesthetic is effective and reliable in producing both akinesia and anaesthesia for cataract surgery. Our clinical experience indicates that it is sometimes necessary when absolute akinesia is required during surgery to augment the block with 1–2 ml of local anaesthetic. Hypothesis was that after first injection some of the volume injected may spill out and before second injection the effect of hyaluronidase has taken place and second volume injectate will have desired effect. Methods A prospective, randomised, control trial in which patients were randomly allocated to one of two groups. In group 1, single injection of 5 ml of local anaesthetic was injected. In group 2, 3 ml of the same anaesthetic solution was injected followed by application of gentle orbital pressure for 2 minutes. A further 2 ml of the same anaesthetic solution was injected through the same conjunctival incision. Measurement of movement in four quadrants of eye was done by the surgeon at 3 and 6 minutes. Intraocular pressure, chemosis, and subconjuctival haemorrhage were also measured. Results Significant differences at 3 minutes between groups for overall movement, medial, superior, and lateral quadrants occurred. At 6 minutes no significant group differences emerged for the overall movement or for any of four quadrants. Conclusion Single injection of local anaesthesia for sub-Tenon's block with mixture of lignocaine with adrenaline, bupivacaine and hyaluronidase was found to be superior to provide akinesia of ocular muscles compared to divided dose given by two injections. No difference in groups in terms of haemorrhage, chemosis, patient's satisfaction and intraocular pressure was found. Trial registration Trial registration no-ISRCTN73431052
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Affiliation(s)
- Ehtesham I Khan
- Dept of Anaesthesia, Cork University Hospital and University College Cork, Ireland, Wilton, Cork, Co Cork, Ireland.
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Current world literature. Curr Opin Ophthalmol 2008; 20:69-72. [PMID: 19077831 DOI: 10.1097/icu.0b013e32831fd89f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:684-93. [DOI: 10.1097/aco.0b013e328312c01b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Delaere L, Zeyen T, Foets B, Van Calster J, Stalmans I. Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review. Int Ophthalmol 2008; 29:521-8. [DOI: 10.1007/s10792-008-9258-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Accepted: 07/11/2008] [Indexed: 11/24/2022]
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