Comparison of Outcomes of Topical Anesthesia with Peribulbar Anesthesia in Vitrectomy for Unresolving Vitreous Hemorrhage

Authors

  • Muhammad Munir Lahore General Hospital, Lahore
  • Hussain Ahmaed Khaqan Lahore General Hospital, Lahore
  • Fahd Kamal Akhtar Central Park Medical College, Lahore
  • Usman Imtiaz Postgraduate Medical Institute, Lahore
  • Abdul Basit Lahore General Hospital, Lahore
  • Raheela Naz Lahore General Hospital, Lahore
  • Mehreen Afzal Lahore General Hospital, Lahore

DOI:

https://doi.org/10.37762/jgmds.9-2.210

Keywords:

Anesthesia, Bupivacaine, Vitreous hemorrhage

Abstract

OBJECTIVES:

To compare the Surgeon's ease level and duration of surgery in topical anesthesia with peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months.

METHODOLOGY:

A randomized controlled trial was carried out at the Department of Ophthalmology, Lahore General Hospital, Postgraduate Medical Institute, Lahore from October 2017 to September 2018. A total of 110 patients were equally divided (n=55) in group A (topical anesthesia) and group B (peribulbar anesthesia) by lottery method. In group A, 0.5% proparacaine hydrochloride eye drops were instilled into the conjunctival sac every 3 minutes preoperatively 5 times before surgery. For group B patients, 5cc injection consisting of 2.5ml of 0.5% bupivacaine and 2.5ml of 1% lidocaine was injected thirty minutes before surgery. Surgical time was noted from first incision to enter the eye for vitrectomy till application of last closing suture. Surgeon ease was recorded with a 4 Grade scale. All data was recorded, entered, and analyzed by SPSS version 25.0. Continuous variables were presented as mean, standard deviation and independent t-test was applied.

RESULTS:

 The mean age of the patient was 43.83±9.76 years. Male cases were 78 (70.9%) and female cases were 32 (29.1%). Mean duration of surgery was 30.32±7.07 minutes and the surgeon’s ease was 2.30±0.98. There was a significant difference (P<0.05) with respect to mean duration of surgery and surgeon’s ease level in patients who were given topical anesthesia (28.12±6.57 minutes and 3.11±0.90) versus peribulbar anesthesia (32.52±6.92 minutes and 2.67±0.90).

CONCLUSION:

Topical anesthesia without sedation is better than peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months.

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Author Biographies

Muhammad Munir, Lahore General Hospital, Lahore

Resident Ophthalmologist, Postgraduate
Medical Institute/Lahore General Hospital, Lahore

Hussain Ahmaed Khaqan, Lahore General Hospital, Lahore

Professor of Ophthalmology,
Postgraduate Medical Institute/Lahore General Hospital, Lahore

Fahd Kamal Akhtar, Central Park Medical College, Lahore

Assistant Professor,
Central Park Medical College, Lahore

Usman Imtiaz , Postgraduate Medical Institute, Lahore

Senior Registrar,
Postgraduate Medical Institute, Lahore

Abdul Basit , Lahore General Hospital, Lahore

Resident Ophthalmologist,
Postgraduate Medical Institute/Lahore General Hospital, Lahore

Raheela Naz, Lahore General Hospital, Lahore

Post Graduate Resident,
Postgraduate Medical Institute/Lahore General Hospital, Lahore

Mehreen Afzal, Lahore General Hospital, Lahore

Post Graduate Resident,
Postgraduate Medical Institute/Lahore General Hospital, Lahore

References

Ahmed SA, Elmawy MG, Awd M. Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: randomized controlled study. Egypt J Anaesth. 2018;34(1):21-5

Ghadiali Q, Ghadiali LK, Schiff WM, Odel JG. Contralateral anesthesia in two patients after retrobulbar block. Retinal Cases Brief Rep. 2018;12(2):97-9

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(1):164

Chandra S, Sugiarto A, Hotasi R, Melati AC, Harmani B. The effectiveness of 2% lidocaine gel compared to 0.5% tetracaine eye drop as topical anesthetic agent for phacoemulsification surgery. Anesth Pain Med. 2018;8(2):e68383

Theventhiran A, Shabsigh M, De Moraes CG, Cioffi GA, Kamel M, Blumberg D, et al. A comparison of retrobulbar versus topical anesthesia in trabeculectomy and aqueous shunt surgery. J Glaucoma. 2018;27(1):28-32

Pereira F, Shiroma HF, Urias MG, Yamada VH, Lima AA, Hofling-Lima AL, et al. Pilot study comparing topical anesthetic agents in pterygium surgery: subconjunctival injection versus 2% lidocaine gel versus 5% lidocaine gel. Cornea. 2018;37(2):194-8.

Chua AWY, Chua MJ, Kam PCA. Recent advances and anaesthetic considerations in corneal transplantation. Anaesth Intensive Care. 2018;46(2)

Abouammoh MA, Abouammoh MA, Gale JS, Arevalo JF, Sharma S. A novel technique for securing sclerotomies in 20-gauge transconjunctival pars plana vitrectomy: surgical outcomes and complications in 529 consecutive cases. Retina. 2016;36(5):974-80

Tayyab H, Khan AA, Sadiq MAA, Karamat I. Comparison of 23 gauge transconjunctival releasable suture vitrectomy with standard 20 gauge vitrectomy. Pak J Med Sci. 2018;34(2):328-32

Trujillo-Sanchez GP, Rosa AG, 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(8):1136-40

Chaudhary RA, Khaqan HA, Ahmad A, Imtiaz U, Raza H, Shabbir U. Comparison of topical versus peribulbar anesthesia for 23G pars plana vitrectomy. J Coll Physicians Surg Pak. 2018;28(6):452-5

Lin FY, Fu MS. Central retinal artery occlusion after uneventful glaucoma valve implantation surgery with retrobulbar anesthesia: a case report. Int J Ophthalmol. 2019;12(8):1362

Papadopoulos M, Grajewski AL, Bitrian E, Freedman SF. Childhood Glaucoma Surgery: Perioperative Considerations. In: Surgical Management of Childhood Glaucoma. Springer, Cham; 2018. p. 1-8

Catalu CT, Istrate SL, Voinea LM, Mitulescu C, Popescu V, Radu C. Ocular implants-methods of ocular reconstruction following radical surgical interventions. Rom J Ophthalmol. 2018;62(1):15

Mitsui K, Kogo J, Takeda H, Shiono A, Sasaki H, Munemasa Y, et al. Comparative study of 27-gauge vs 25-gauge vitrectomy for epiretinal membrane. Eye. 2016;30(4):538-44

Olsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, et al. Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med. 2017;15(1):1-8

Tolesa K, Gebreal GW. Brainstem anesthesia after retrobulbar block: a case report and review of literature. Ethiop J Health Sci. 2016;26(6):589-94

Smolka W, Knoesel T, Mueller-Lisse U. Local anesthetic-induced myotoxicity as a cause of severe trismus after inferior alveolar nerve block. Quintessence Int. 2018;49(5)

Yonekawa Y, Tang PH, Yannuzzi NA, Swaminathan SS, Hussain R, Sridhar J, et al. Repair of rhegmatogenous retinal detachment following globe perforation by retrobulbar anesthesia. Ophthalmic Surg Lasers Imaging Retina. 2020;51(4):249-51

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(1):1-6

Adinehmehr L, Shetabi H, Farsani DM, Salehi A, Noorbakhsh M. Comparison of the sedation quality of etomidate, propofol, and midazolam in combination with fentanyl during phacoemulsification cataract surgery: a double-blind, randomized, controlled, clinical trial. Anesthesiol Pain Med. 2019;9(2)

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Published

2022-04-06

How to Cite

Munir, M., Khaqan, H. A., Akhtar, F. K. ., Imtiaz , U. ., Basit , A. ., Naz, R. ., & Afzal, M. . (2022). Comparison of Outcomes of Topical Anesthesia with Peribulbar Anesthesia in Vitrectomy for Unresolving Vitreous Hemorrhage. Journal of Gandhara Medical and Dental Science, 9(2), 60–64. https://doi.org/10.37762/jgmds.9-2.210