Abstract
We report our experience of a recently described local anaesthetic technique which seeks to avoid risk of perforation of the globe, damage to the optic nerve, or injection into the subarachnoid space, whilst providing prolonged and reliable anaesthesia. A prospective series of 19 patients who underwent vitreoretinal surgery using this technique were compared with 19 patients who had retrobulbar anaesthesia for cataract extraction. The vitreoretinal group had excellent akinesia and very good anaesthesia, allowing prolonged retinal reattachment surgery lasting up to 3 hours. Patient evaluation of discomfort or pain experienced in the two groups was assessed using a visual analogue pain score chart. The pain scores for the two groups were not significantly different (p = 0.03) and 16 of 19 patients in each group (84%) experienced only slight pain or less. Satisfaction with local anaesthesia, in both groups, was also assessed by asking patients which method of anaesthesia they would prefer if future surgery were to be performed. In the vitreoretinal group, 18 of 19 patients expressed a preference for local anaesthesia and in the cataract group 17 ot 19 also favoured local anaesthesia. The vitreoretinal patients' median pain score was 0 compared with 1 for the cataract patients. This study demonstrates that local anaesthesia provides pain relief for vitreoretinal surgery which is comparable to the experience of patients undergoing cataract surgery by retrobulbar anaesthesia. The technique described can provide successful local anaesthesia for vitreoretinal procedures. The success of this technique for pain relief and akinesia calls for a reappraisal of the number of patients suitable for vitreoretinal surgery under local anaesthesia.
Similar content being viewed by others
Article PDF
References
Mein CE and Woodcock MG : Local anaesthesia for vitreoretinal surgery. Retina 1990, 10: 47–9.
Ramsay RC and Knobloch WH : Ocular perforation following retrobulbar anaesthesia for retinal detachment surgery. Am J Ophthalmol 1978, 86: 61–4.
Feibel RM : Current concepts in retrobulbar anaesthesia. Surv Ophthalmol 1985, 30: 102–10.
Brookshire GE, Gleitsman KY, Shenk EC : Life-threatening complication of retrobulbar block. Ophthalmology 1986, 93: 1476–8.
Ohnhaus EE, Adler R : Methodological problems in the measurement of pain: a comparison between the verbal rating scale and visual analogue scale. Pain 1975, 1: 375–84.
Revill SI, Robinson JO, Rosen M, Hogg MIJ : The reliability of a linear analogue for evaluating pain. Anaesthesia 1976, 31: 1191–8.
Scott J and Huskisson EC : Graphic representation of pain. Pain 1976, 2: 175–84.
Walsh FB and Hoyt WF : Sensory innervation of the eye and orbit. In: Clinical Neuro-ophthalmology, 3rd edn. Baltimore: Williams & Wilkins, 1969.
Isemhagen RD, Michels RG, Glaser BM, de Bustros S, Enger C : Hospitalization requirements after vitreoretinal surgery. Arch Ophthalmol 1988, 106: 767–70.
Wilson D and Barr CC : Outpatient and abbreviated hospitalization for vitreoretinal surgery. Ophthalmic Surg 1990, 21: 119–22.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stevens, J., Franks, W., Orr, G. et al. Four-quadrant local anaesthesia technique for vitreoretinal surgery. Eye 6, 583–586 (1992). https://doi.org/10.1038/eye.1992.126
Issue Date:
DOI: https://doi.org/10.1038/eye.1992.126
Keywords
This article is cited by
-
Expanding role of local anaesthesia in vitreoretinal surgery
Eye (2005)
-
Comparison of sub-Tenon's anaesthesia by different delivery techniques in cataract surgery
Eye (1999)
-
Local anaesthesia for vitreoretinal surgery: A case-control study of 200 cases
Eye (1998)
-
Peribulbar anaesthesia for cataract surgery: Prilocaine versus lignocaine and bupivacaine
Eye (1996)
-
Failure of topical bupivacaine to relieve pain after vitreoretinal surgery
Eye (1994)