Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial

• Published in: PloS one 2020-08, Vol.15 (8), p.e0236624-e0236624
• Main Authors: Ribeiro, Jefferson A.S, Ribeiro, Daniel S, Scott, Ingrid U, Abrao, Joao, Jorge, Rodrigo
• Format: Article
• Language: English
• Subjects: Anesthesia; Biology and Life Sciences; Cataracts; Cocaine; Comparative analysis; Complications and side effects; Demographics; Demography; Diabetes; Diabetic retinopathy; Drug therapy; Eye surgery; General anesthesia; Health sciences; Hemorrhage; Hypertension; Informed consent; Intravenous administration; Lidocaine; Local anesthesia; Medical materials; Medical schools; Medicine and Health Sciences; Ophthalmology; Optic nerve; Pain; Patient outcomes; Patients; Perforation; Postoperative pain; Randomization; Retina; Ribeiro, Daniel; Risk management; Risk reduction; Ropivacaine; Sheaths; Studies; Surgery; Tubes; Vitrectomy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0236624

To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia. 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). 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.