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Ma X, Liang Q, Xue S, Ren Q, Du Q, Zhang Z, Li X, Liu X, Gao Y, Li J. EFFECT OF ANESTHESIA DURATION ON INTRAVITREAL INJECTION PAIN: A double-blinded, randomized, comparative study. Retina 2023; 43:1386-1392. [PMID: 37130433 DOI: 10.1097/iae.0000000000003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE To determine the effect of different durations of topical anesthesia on intravitreal injection (IVI) pain. METHODS This was a double-blinded, randomized, comparative study . Three hundred and twelve sequential eyes undergoing IVI were randomized to one of six groups according to the duration of topical anesthesia (from 1 to 30 minutes, one group for every 5-minute range, Groups 1-6). Topical anesthesia before IVI was standardized. Patients graded their pain using the visual analog scale and the Wong-Baker FACES scale at 15 minutes after the procedure. RESULTS The pain scores among the six groups were significantly different for the visual analog scale ( P = 0.013) and Wong-Baker FACES scale ( P = 0.024). The mean pain scores for Group 4 were 1.97 ± 1.04 (visual analog scale) and 2.02 ± 1.08 (Wong-Baker FACES scale) and were significantly lower than those of Group 1, 2, 5, or 6. CONCLUSION The duration of topical anesthesia significantly correlated with IVI pain. Preoperative 0.5% proparacaine hydrochloride drops were most effective in relieving IVI pain 11 to 20 minutes after topical administration.
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Affiliation(s)
- Xiubin Ma
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Qianqian Liang
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Shuyue Xue
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Qi Ren
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Qing Du
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Zhichun Zhang
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Xinying Li
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Xin Liu
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Yan Gao
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Jun Li
- Department of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China; and
- Department of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Qingdao, China
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Pucchio A, Pur DR, Dhawan A, Sodhi SK, Pereira A, Choudhry N. Anesthesia for ophthalmic surgery: an educational review. Int Ophthalmol 2022. [PMID: 36436168 DOI: 10.1007/s10792-022-02564-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Selecting an anesthetic agent for ophthalmic surgery has crucial implications for the surgeon, anesthesiologist, and patient. This educational review explores the common classes of anesthesia used in ophthalmology. Additionally, we discuss the considerations unique to cataract, glaucoma, strabismus, orbital, oculoplastic, and ocular trauma surgeries. METHODS A comprehensive Embase search was performed using combinations of the subject headings "anesthesia", "eye surgery", "ophthalmology" and "cataract extraction", "glaucoma", "strabismus", "vitreoretinal surgery", "retina surgery", "eye injury", and "eyelid reconstruction". RESULTS Topical anesthetics are the most commonly used form of ocular anesthesia, used in both an office and surgical setting, and carry a minimal side effect profile. Notably, topical anesthetics offer analgesia, but do not provide akinesia or amnesia. Regional blocks, such as are sub-Tenon's, peribulbar, and retrobulbar blocks, are used when akinesia is required in addition to analgesia. Recently, sub-Tenon's blocks have recently gained popularity due to their improved safety profile compared to other regional blocks. General anesthesia is considered for long, complex surgery, surgery in patients with multiple comorbidities, surgery in young pediatric patients, or surgery in patients intolerant to local or regional anesthetic. CONCLUSION Anesthetizing the eye has rapidly evolved in recent years, supporting the safety, efficacy and comfort of ocular surgery. Since there are many viable options of anesthetics available for ophthalmic surgery, a robust understanding of the patients needs, the skill of the surgical team, and surgery-specific factors ought to be considered when creating an anesthetic plan for surgery.
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Alpay A, Güney T. Evaluating the effectiveness of localized sub-Tenon's anesthesia in 23-gauge vitreoretinal surgery. Int Ophthalmol 2021; 41:195-201. [PMID: 32902785 DOI: 10.1007/s10792-020-01566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effectiveness of localized sub-Tenon's anesthesia for pain control during 23-gauge vitreoretinal surgery. METHODS Eighty patients were randomly divided into two groups as localized sub-Tenon's (group 1, n = 41) and retrobulbar (group 2, n = 39) anesthesia groups. In group 1, a small volume of anesthetic was injected into the sub-Tenon's capsules at the trocar entry sites. The 23-gauge vitreoretinal surgery was performed in all patients. In both groups, the pain levels during the surgical steps were evaluated using the visual analog pain scale. RESULTS Patients in group 1 experienced less pain than group 2 patients did during placement of the trocars and scleral depression (p = 0.041, p = 0.029). Pain during laser photocoagulation was higher in group 1 (p = 0.008). There was no serious complication due to anesthesia or surgery. CONCLUSION Localized sub-Tenon's anesthesia is as effective as retrobulbar anesthesia in many steps of vitreoretinal surgery for providing pain control. It can be considered an alternative form of local anesthesia.
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Ribeiro JAS, Ribeiro DS, Scott IU, Abrão J, Jorge R. Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial. PLoS One 2020; 15:e0236624. [PMID: 32760093 PMCID: PMC7410239 DOI: 10.1371/journal.pone.0236624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia. Methods Prospective, 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. Results Fifty-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). Conclusion In 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.
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Affiliation(s)
- Jefferson A. S. Ribeiro
- Superior School of Health Sciences, Amazonas State University, Manaus, AM, Brazil
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- * E-mail:
| | - Daniel S. Ribeiro
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ingrid U. Scott
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - João Abrão
- Department of Biomechanics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Fan H, Qian Z, Tzekov R, Lin D, Wang H, Li W. A New Two-Step Anesthesia for 23- or 25-Gauge Vitrectomy Surgery: A Prospective, Randomized Clinical Trial. Ophthalmic Res 2020; 64:34-42. [PMID: 32388512 DOI: 10.1159/000508510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of topical anesthesia combined with subconjunctival anesthesia (termed two-step anesthesia) for 23- or 25-gauge pars plana vitrectomy or other posterior segment surgery. METHODS Patients (n = 90) requiring 23-/25-gauge vitrectomy or other posterior segment surgery were randomized into 3 groups. Group 1 received peribulbar anesthesia, group 2 received retrobulbar anesthesia and group 3 received two-step anesthesia. A 5-point visual analog pain scale (VAPS) was used to measure self-report of patient pain. Complications were recorded for subsequent analysis. RESULTS VAPS scores for overall intraoperative pain ranged from 0 to 3 (1.07 ± 1.07) in group 1, from 0 to 2 (0.69 ± 0.93) in group 2 and from 0 to 3 (1.06 ± 0.98) in group 3. Assessment of surgeon discomfort score ranged from 0 to 2 (0.31 ± 0.66) in group 1, from 0 to 3 (0.38 ± 0.82) in group 2 and from 0 to 2 (0.47 ± 0.62) in group 3. Both scores reveal no significant difference among the 3 groups. While there were no complications noted in group 1, there was an ocular perforation in group 2. Additionally, there were no complications in group 3 related to the anesthetic technique. CONCLUSIONS Results suggest that two-step anesthesia is a safe and effective anesthetic approach for selected patients undergoing 23- or 25-gauge pars plana vitrectomy or other posterior segment surgeries. It may offer a viable alternative to peribulbar anesthesia and retrobulbar anesthesia for carefully selected 23- or 25-gauge cannular-access ocular surgeries.
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Affiliation(s)
- Hua Fan
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Zhuyun Qian
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, Florida, USA
| | - Dong Lin
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Hongxia Wang
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Wensheng Li
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China, .,Aier School of Ophthalmology, Central South University, Changsha, China,
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Trujillo-Sanchez GP, Rosa AGDL, Navarro-Partida J, Haro-Morlett L, Altamirano-Vallejo JC, Santos A. Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2018; 67:182-183. [PMID: 30574949 PMCID: PMC6324093 DOI: 10.4103/ijo.ijo_1516_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gloria P Trujillo-Sanchez
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
| | - Alejandro Gonzalez-De la Rosa
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
| | - Luis Haro-Morlett
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
| | - Juan C Altamirano-Vallejo
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
| | - Arturo Santos
- Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
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Trujillo-Sanchez GP, Gonzalez-De La Rosa A, Navarro-Partida J, Haro-Morlett L, Altamirano-Vallejo JC, Santos A. Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2018; 66:1136-1140. [PMID: 30038158 PMCID: PMC6080475 DOI: 10.4103/ijo.ijo_289_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the feasibility and safety of office-based vitreoretinal procedures. Methods Patients undergoing primary elective pars plana vitrectomy were elected for surgery in an office-based setting (performed in a minor procedure room under topical anesthesia [TA] and oral anxiolysis). Rates of surgical objective achievement, surgical timing, and comfort were recorded to evaluate feasibility. Intraoperative and postoperative adverse events were assessed to evaluate safety. Results Office-based vitrectomy surgery was performed in 34 eyes of 30 patients. The mean surgical time was 12.351 ± 8.21 min. Surgical objectives were achieved in 100% of cases. The mean best-corrected visual acuity improvement was 9.08 letters (P < 0.0001). During most parts of the procedure, no patient reported pain or discomfort. Neither intraoperative nor postoperative adverse events were reported until the final follow-up visit. Conclusion Office-based vitreoretinal procedures under TA could be as feasible and as safe as vitreoretinal procedures under conventional anesthesia.
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Affiliation(s)
| | - Alejandro Gonzalez-De La Rosa
- Centro De Retina Médica Y Quirúrgica, S.C., Centro Médico Puerta De Hierro; Tecnologico De Monterrey, Escuela De Medicina Y Ciencias De La Salud, Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- Tecnologico De Monterrey, Escuela De Medicina Y Ciencias De La Salud, Zapopan, Jalisco, México
| | - Luis Haro-Morlett
- Centro De Retina Médica Y Quirúrgica, S.C., Centro Médico Puerta De Hierro, Zapopan, Jalisco, México
| | - Juan Carlos Altamirano-Vallejo
- Centro De Retina Médica Y Quirúrgica, S.C., Centro Médico Puerta De Hierro; Tecnologico De Monterrey, Escuela De Medicina Y Ciencias De La Salud, Zapopan, Jalisco, México
| | - Arturo Santos
- Centro De Retina Médica Y Quirúrgica, S.C., Centro Médico Puerta De Hierro; Tecnologico De Monterrey, Escuela De Medicina Y Ciencias De La Salud, Zapopan, Jalisco, México
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Wu RH, Zhang R, Lin Z, Liang QH, Moonasar N. A comparison between topical and retrobulbar anesthesia in 27-gauge vitrectomy for vitreous floaters: a randomized controlled trial. BMC Ophthalmol 2018; 18:164. [PMID: 29981573 PMCID: PMC6035792 DOI: 10.1186/s12886-018-0838-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background To compare the safety and efficacy of topical anesthesia versus retrobulbar anesthesia in 27-gauge pars plana vitrectomy (PPV) for vitreous floaters. Methods 30 patients with vitreous floaters were randomized into Group T (topical anesthesia, proparacaine eye drop) and Group R (retrobulbar anesthesia), and underwent 27-gauge PPV. A 5-point visual analogue pain scale (VAPS) was used to assess patients’ pain experience of anesthesia and surgery procedure (during surgery, 2 h and 1 day after surgery). Results The VAPS of anesthesia procedure was 1.27 ± 0.59 for patients in Group R, while it was all 0 for patients in Group T (p < 0.001). There was no significant difference for VAPS during surgery (Group T: 1.13 ± 0.74, Group R: 0.67 ± 0.62, p = 0.67), 2 h (Group T: 0.80 ± 1.01, Group R: 0.67 ± 0.62, p = 0.67) and 1 day (Group T: 0.20 ± 0.41, Group R: 0.27 ± 0.46, p = 0.68) after surgery between these two groups. Only one patient (6.7%) in Group T required additional topical anesthesia during the surgery. Most of the patients reported the pain experience came from initial trocar insertion in both groups. None of the patients required post operative analgesia in both groups. No intraoperative or postoperative complications were noted in both groups. Conclusion This study suggested that topical anesthesia is a safe and effective anesthetic approach for patients with floaters who underwent 27-gauge PPV. Trial registration ClinicalTrials.govNCT03049163. Registered 8 February 2017. Electronic supplementary material The online version of this article (10.1186/s12886-018-0838-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rong Han Wu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Rui Zhang
- Liaocheng People's Hospital of Shandong Province, Liaocheng, Shandong, China
| | - Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China.
| | - Qi Hua Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
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Abstract
CONTEXT: Topical anesthesia has been used for pars plana vitrectomy (PPV) with limited patient comfort. Thus, augmenting topical anesthesia with intracameral anesthesia (Trojan horse anesthesia) will provide pain-free experience during PPV. AIMS: This study was undertaken to evaluate the patient comfort and surgical safety using 2% lignocaine jelly augmented with intracameral 1.0% lignocaine solution for anesthetizing the eyes undergoing PPV. SETTINGS AND DESIGN: This was a prospective interventional case series at tertiary care hospital. SUBJECTS AND METHODS: Patients planned for PPV for indications other than retinal detachment were included in the study. The pain perception of the participants undergoing PPV under Trojan horse anesthesia was evaluated using visual analog scale (VAS). STATISTICAL ANALYSIS USED: Data analysis was done using descriptive statistics and nonparametric analysis with level of significance at P < 0.05. RESULTS: There were 114 eyes of 114 patients in the study out of which 68.4% (n = 78) were males. The mean age was 42.31 years (range 14–80 years, standard deviation [SD] 18.7). The mean surgical time was 34.0 min (range 13–80 min, SD 14.2). The pain perception on VAS scale averaged 3.0 (range 0–8, SD 1.59, median 3.0). Pain scores were not affected by the age (Pearson correlation = 0.098, P = 0.3), gender (P = 0.44), or the educational status of the participant (P = 0.28). The pain scores were not affected by the indications of surgery (P = 0.58) or the use of silicone oil (P = 0.07). CONCLUSIONS: Trojan horse anesthesia provides adequate analgesia for comfortable and safe 23-gauge PPV with high patient acceptability.
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Affiliation(s)
- Sanjiv Kumar Gupta
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajai Kumar
- Jankalyan Eye Hospital, Lucknow, Uttar Pradesh, India
| | - Arun Sharma
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Khan MA, Kuley A, Riemann CD, Berrocal MH, Lakhanpal RR, Hsu J, Sivalingam A, Ho AC, Regillo CD. Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease. Ophthalmology 2018; 125:423-431. [DOI: 10.1016/j.ophtha.2017.09.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/10/2017] [Accepted: 09/12/2017] [Indexed: 11/15/2022] Open
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Lin Z, Moonasar N, Wu RH, Seemongal-Dass RR. 27-Gauge Vitrectomy for Symptomatic Vitreous Floaters with Topical Anesthesia. Case Rep Ophthalmol 2017; 8:35-39. [PMID: 28203195 PMCID: PMC5301096 DOI: 10.1159/000453332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose Traditionally acceptable methods of anesthesia for vitrectomy surgery are quite varied. However, each of these methods has its own potential for complications that can range from minor to severe. The surgery procedure of vitrectomy for symptomatic vitreous floaters is much simpler, mainly reflecting in the nonuse of sclera indentation, photocoagulation, and the apparently short surgery duration. The use of 27-gauge cannulae makes the puncture of the sclera minimally invasive. Hence, retrobulbar anesthesia, due to its rare but severe complications, seemed excessive for this kind of surgery. Method Three cases of 27-gauge, sutureless pars plana vitrectomy for symptomatic vitreous floaters with topical anesthesia are reported. Results The vitrectomy surgeries were successfully performed with topical anesthesia (proparacaine, 0.5%) without operative or postoperative complications. Furthermore, none of the patients experienced apparent pain during or after the surgery. Conclusion Topical anesthesia can be considered for 27-guage vitrectomy in patients with symptomatic vitreous floaters.
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Affiliation(s)
- Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Nived Moonasar
- Ophthalmology Department, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Rong Han Wu
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Robin R Seemongal-Dass
- Ophthalmology Department, University of the West Indies, St. Augustine, Trinidad and Tobago
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Abstract
PURPOSE OF REVIEW The history and development of 25-gauge transconjunctival sutureless vitrectomy are reviewed in this paper. The expanded spectrum of appropriate cases and recent innovations in vitrectomy surgery are discussed, as are longer-term outcomes and possible complications. RECENT FINDINGS 25-Gauge pars plana vitrectomy has evolved significantly since its introduction in 2002, with newer instruments and novel techniques expanding the scope and improving outcomes in vitreoretinal surgery. Proper case selection is imperative, as the smaller scale of the instruments and decreased fluidics work most efficiently when extensive manipulation of intraocular tissue or significant membrane dissection is not required. Unique complications of 25-gauge surgery such as hypotony and a possible increased rate of endophthalmitis may be related to unsutured sclerotomies, and revisions in surgical approach may help to decrease these potentially devastating complications. SUMMARY Clinical experience over the last several years has proven that this sutureless system is both safe and efficacious. Decreased surgical times, reduced postoperative inflammation, and more rapid patient recovery have all contributed to an increased acceptance of 25-gauge vitrectomy by retinal physicians.
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Affiliation(s)
- Eric Chen
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.
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