Contact-topical plus intracameral lidocaine versus peribulbar anesthesia in combined surgery: a randomized clinical trial

A Comparison of Retrobulbar Versus Topical Anesthesia in Trabeculectomy and Aqueous Shunt Surgery

PURPOSE

The purpose of this study was to compare the required supplemental anesthesia and postoperative patient pain score in individuals undergoing glaucoma surgery under topical anesthesia (TA) versus retrobulbar anesthesia (RB).

MATERIALS AND METHODS

A retrospective, interventional, comparative cohort study of 261 eyes of 225 patients undergoing glaucoma and combined glaucoma with cataract surgery were included in the study. The main outcome measures were the amount of supplemental, systemic intraoperative anesthesia used and the postoperative pain scale between patients undergoing TA versus RB anesthesia. A secondary analysis was performed between combined glaucoma and cataract surgery versus glaucoma surgery alone.

RESULTS

About 6.2% patients complained of pain after glaucoma surgery (8.1% among TA group and 3.1% among RB group; P=0.049). Overall, pain tended to be mild with a mean score of 0.32 of 10 for TA and 0.08 of 10 for RB (P=0.027). The amount of IV anesthetics used intraoperatively was lower in the RB anesthesia compared with the TA group (midazolam, P=0.042; fentanyl, P<0.001; propofol, P<0.001). In addition, patients undergoing RB anesthesia were less likely to use postoperative pain medication (P<0.001). There was no difference in pain score (P=0.707) or in the amount of IV anesthetics (all P>0.350) between eyes undergoing combined versus glaucoma surgery alone.

CONCLUSIONS

Although supplemental anesthesia and pain scores were statistically increased in the topical group, the prevalence and the severity of pain was low. Therefore, TA is feasible and a reasonable option for glaucoma surgery. Furthermore, this conclusion applies when glaucoma surgery is performed alone or in combination with the other eye surgery.

Comparison of clinical outcomes, patient, and surgeon satisfaction following topical versus peribulbar anesthesia for phacoemulsification and intraocular lens implantation: a randomized, controlled trial

Background:

Both cataract surgery and anesthesia techniques are rapidly evolving to become more patient friendly. However, comparison of topical anesthesia (TA) and peribulbar anesthesia (PA) for phacoemulsification and cataract surgery is limited. We evaluated the clinical outcomes and patient and surgeon satisfaction between anesthetic techniques.

Materials and Methods:

This randomized clinical trial was conducted between January and June 2012. Patients were randomly assigned to TA and PA groups for surgery. Visual acuity at 4 weeks postoperatively, status of the cornea and the wound and intraoperative complications were compared between groups at day 1, and 1 and 4 weeks after surgery. Patients and the surgeon completed a close-ended questionnaire on satisfaction with analgesia and comfort. The relative risk (RR) with 95% confidence intervals (CI) was calculated.

Result:

There were 500 patients in each group. There were no significant differences between groups preoperatively. Complications at 1-day postoperatively were significantly greater in the TA group (RR = 1.36, 95% CI: 1.17–1.58). Satisfaction with the mitigation of pain was statistically significantly greater in the PA group compared to the TA group (χ² = 10.9, df = 3, P = 0.001). Surgeons were more satisfied with PA compared to TA (RR = 1.4, 95% CI: 1.34–1.63). There were more anesthesia-related complications in the PA group compared to the TA group.

Conclusions:

Patients who underwent surgery with topical anesthetic experienced lower complications by more pain compared to patients who underwent PA. Topical anesthetic supplemented with analgesic medications could help the patient and surgeon during cataract surgery.

The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia

Purpose: To evaluate and compare the safety and efficacy of combined two-site phacoemulsification and trabeculectomy surgery with mitomycin C (MMC) in glaucoma-cataract patients with retrobulbar or topical anesthesia.

Patients and methods: A retrospective, nonrandomized review of consecutive phacotrabeculectomy patients with a minimum follow-up time of 6 months, no previous glaucoma surgeries, and a preoperative visual acuity (VA) greater than light perception. The main outcome measures were preoperative and postoperative VA, intraocular pressure (IOP), use of glaucoma medications, and complications. A complete surgical success required an IOP from 6 to 18 mm Hg, no visually devastating complications, no return to surgery, and no use of glaucoma medications. Qualified success allowed the use of up to two glaucoma medications. Anesthesia groups were compared by student t-tests and log rank comparison of Kaplan-Meier survival rates.

Results: Eighty-seven eyes (83 patients) met inclusion criteria, with a mean follow-up of 19 ± 12 months (6-57 months). The average eye gained 3.1 ± 4.9 lines of VA, lost 4.0 ± 7.1 mm Hg of IOP, and decreased 1.0 ± 1.3 glaucoma medications. Retrobulbar and topical anesthesia groups had statistically equivalent mean changes in VA (p = 0.910), IOP (p = 0.268), and use of glaucoma medications (p = 0.964). Postoperative complication rates were also statistically similar (p = 0.580). Complete success was greater in the retrobulbar group (p = 0.006), however, qualified success was equivalent in both groups (p = 0.769).

Conclusion: Two-site phacotrabeculectomy with MMC in West Indian patients is as safe and effective for glaucoma-cataract patients with topical anesthesia as it is under retrobulbar anesthesia, and without short-term losses in VA and the chance of serious complications from injection.

How to cite this article: Rodriguez R, Alburquerque R, Sauer T, Batlle JF. The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia. J Curr Glaucoma Pract 2016;10(1):7-12.

The Blitz Anesthesia Technique in Non-English Speaking Patients Undergoing Glaucoma Surgery

AIM

To describe a less invasive method of providing anesthesia in non-English speaking patients undergoing glaucoma surgery.

SETTINGS AND DESIGN

Prospective observational study conducted in a tertiary Care Eye Institute, Wills Eye Institute, Philadelphia, PA, USA.

MATERIALS AND METHODS

The blitz anesthesia technique was applied to 15 non-English speaking patients (Vietnamese, Mandarin, Russian and Korean) during glaucoma surgery. With input from family members, a diagram was created for each patient. The diagram consisted of a translation and phonetic guide to pronunciation of common words or phrases in the patient's native language that might be used by the surgical team during the operation.

RESULTS

The blitz anesthesia technique worked well to provide patient comfort during the procedures. All patients reported adequate pain control and described their experience as comfortable. Additionally, patients reported feeling reassured that they were able to understand basic information from the surgical team during their case. This technique decreased patient anxiety prior to and during the surgical procedure.

CONCLUSION

Blitz anesthesia provided adequate pain control with no complications.

KEY MESSAGE

Blitz anesthesia with a phonetic language diagram, a less invasive technique of providing anesthesia in non-English speaking patients undergoing glaucoma surgery.

HOW TO CITE THIS ARTICLE

Almodin J, Ichhpujani P, Prasad A, Fudemberg SJ, Moster MR. The Blitz Anesthesia Technique in Non-English Speaking Patients Undergoing Glaucoma Surgery. J Current Glau Prac 2012;6(2):91-93.

[Anesthesia in glaucoma surgery]

Various types of anesthesia, as well as different surgical techniques are available in glaucoma surgery. This study's purpose is to review and update the different possibilities of anesthesia according to the various types of surgical procedures in glaucoma. The different types of anesthesia for glaucoma surgery are general anesthesia, local anesthesia or topical anesthesia. In children, general anesthesia has an absolute indication, whatever the surgical procedure to be used. In adults, literature demonstrates that local anesthesia (retrobulbar or peribulbar) is the most frequently used technique. There is a growing interest in topical anesthesia, which has brought many advantages, for glaucoma surgery (trabeculectomy, deep sclerectomy, aqueous shunt surgery and combined procedures). Choice among the different modalities of anesthesia has to be done according to various parameters based on both patient and surgeon point of view. A close link between surgeon and anesthesiologist is of an utmost importance to ensure the most efficient, comfortable, and appropriate anesthesia for each individual patient.

[Topical versus peribulbar anesthesia in nonpenetrating deep sclerectomy]

INTRODUCTION

Ophthalmic surgery has developed enormously over the past few years. Topical anesthesia is a safe and current procedure in cataract surgery, giving patients quicker and more comfortable recovery. Some authors have used this type of anesthesia for trabeculectomy with good results. This study aims to assess the patient's pain and comfort during and 1 day after nonpenetrating deep sclerectomy compared to peribulbar anesthesia.

METHOD

A visual analog pain scale (0-10) was applied to 69 patients 15 min and 24 h after a nonpenetrating deep sclerectomy procedure. Topical anesthesia (proximetacaine 0.5% drops) associated with an intravenous sedation with propofol was used in 36 patients (group 1) and peribulbar anesthesia (lidocaine 2% associated with bupivacaine 0.75%) was given to 33 patients (group 2) in a randomized and prospective way. The surgical team was the same for all procedures. Results were compared using a Mann-Whitney U test.

RESULTS

Mean age (+/- standard deviation) was 60.25+/-15.90 years in group 1 and 59.15+/-15.36 years in group 2 (p=0.871). For the first evaluation (15 min after surgery), the mean values and their respective deviations were the following: 0.11 +/- 0.40 (0-2) in group 1 and 0.82+/-1.49 (0-5) in group 2 (p=0.014). After 24 h, the mean values and deviations were as follows: 2.83 +/- 1.34 (1-6) in group 1 and 2.45+/-2.09 (0-8) in group 2 (p=0.125).

DISCUSSION

Pain perception by the patient undergoing nonpenetrating deep sclerectomy was statistically different between the two groups in the first evaluation (15 min after the procedure). The topical anesthesia (associated with propofol sedation) group had less pain sensation. The first 24 h assessment showed no significant difference between the groups.

CONCLUSION

Topical anesthesia (associated with propofol sedation) is a valuable and interesting alternative for patients undergoing nonpenetrating deep sclerectomy, providing the same or slightly better comfort than peribulbar anesthesia.