Title

Pain During Pars Plana Vitrectomy Following Sub-Tenon versus Peribulbar Anesthesia: a randomised trial

Introduction

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 who needed PPV for macular hole or epiretinal membrane at the Retina and Vitreous Section of the Department of Ophthalmology in a public hospital of São Paulo were randomly assigned to one of two groups at a ratio of 1:1. In Group ST, patients received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2-4 ml of 10% ropivacaine. In Group PB, patients received peribulbar anesthesia with 4-6 ml of 10% 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 PB). Baseline characteristics, including gender, age 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) was similar between groups. No patients needed supplemental topical or intravenous anesthesia during the surgery. No sight- or life-threatening complication was observed in both groups. VAS score was significantly lower for the ST compared to the PB group (mean ± SEM, 2.4 ± 0.7 for ST versus 17.5 ± 3.2 for PB, p< 0.0001, Wilcoxon).

Discussion

In this study topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia.

Keywords

Pain, vitrectomy, anesthesia, sub-Tenon.

Area

SURGICAL CASE

Authors

Rodrigo Jorge, Jeffeson Augusto Santana Ribeiro, Daniel Santana Ribeiro, Ingrid U. Scott, João Abrão