Comparison of retrobulbar and sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery

Michael M. Lai, James C. Lai, Wen-Hsiang Lee, John J. Huang, Saurabh Patel, Howard S. Ying, Michele Melia, Julia A. Haller, James T. Handa

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: To compare the efficacy and efficiency of retrobulbar versus sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery. Design: Prospective, randomized, double-masked clinical trial. Participants and Intervention: Sixty-four eyes from 61 patients undergoing vitreoretinal surgery were randomized to receive either retrobulbar or sub-Tenon's capsule injection of 5 ml of a 50:50 mixture of 4% lidocaine and 0.75% bupivacaine. Main Outcome Measures: The primary outcome measured was intraoperative eye pain, which was rated by patients in both groups using an 11-point (0-10) numerical visual analogue scale immediately after surgery and again the next morning. The surgeons indicated whether they perceived patient discomfort during 4 different stages of the operation: opening of the conjunctiva, vitrectomy (if performed), placement of scleral buckle (if performed), and closing of the conjunctiva. The preincision time, need for supplemental local anesthesia, and use of IV sedation for additional pain control were compared between the two groups. Results: Thirty-four eyes were randomized to retrobulbar injections, and 30 eyes were randomized to sub-Tenon's capsule injections. There was no significant difference in patient-reported intraoperative pain scores between the retrobulbar and sub-Tenon's capsule groups when assessed immediately after surgery (median, 2.0 vs. 2.0; P = 0.52) or the next day (median, 2.0 vs. 1.0; P = 0.26). The surgeons reported no difference between the two groups in terms of the percentages of patients with pain during opening of the conjunctiva (20.6% vs. 3.3%; P = 0.058), vitrectomy (31% vs. 32%; P = 1.00), placement of scleral buckle (33.3% vs. 40%; P = 1.00), and closing of the conjunctiva (26.5% vs. 26.7%; P = 1.00). There was a suggestion that preincision time was longer in the sub-Tenon's capsule group. Approximately equal percentages of patients in each group required supplemental local anesthesia (38% vs. 37%; P = 0.90) or IV medication (85% vs. 70%; P = 0.14) for pain control. Conclusions: Sub-Tenon's capsule injection of local anesthetic seems as effective as retrobulbar injection at controlling intraoperative pain in vitreoretinal surgery.

Original languageEnglish
Pages (from-to)574-579
Number of pages6
JournalOphthalmology
Volume112
Issue number4
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

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Tenon Capsule
Vitreoretinal Surgery
Local Anesthetics
Conjunctiva
Injections
Pain
Vitrectomy
Local Anesthesia
Eye Pain
Bupivacaine
Lidocaine
Visual Analog Scale
Outcome Assessment (Health Care)
Clinical Trials

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Lai, M. M., Lai, J. C., Lee, W-H., Huang, J. J., Patel, S., Ying, H. S., ... Handa, J. T. (2005). Comparison of retrobulbar and sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery. Ophthalmology, 112(4), 574-579. https://doi.org/10.1016/j.ophtha.2004.10.043

Comparison of retrobulbar and sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery. / Lai, Michael M.; Lai, James C.; Lee, Wen-Hsiang; Huang, John J.; Patel, Saurabh; Ying, Howard S.; Melia, Michele; Haller, Julia A.; Handa, James T.

In: Ophthalmology, Vol. 112, No. 4, 01.04.2005, p. 574-579.

Research output: Contribution to journalArticle

Lai, MM, Lai, JC, Lee, W-H, Huang, JJ, Patel, S, Ying, HS, Melia, M, Haller, JA & Handa, JT 2005, 'Comparison of retrobulbar and sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery', Ophthalmology, vol. 112, no. 4, pp. 574-579. https://doi.org/10.1016/j.ophtha.2004.10.043
Lai, Michael M. ; Lai, James C. ; Lee, Wen-Hsiang ; Huang, John J. ; Patel, Saurabh ; Ying, Howard S. ; Melia, Michele ; Haller, Julia A. ; Handa, James T. / Comparison of retrobulbar and sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery. In: Ophthalmology. 2005 ; Vol. 112, No. 4. pp. 574-579.
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abstract = "Objective: To compare the efficacy and efficiency of retrobulbar versus sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery. Design: Prospective, randomized, double-masked clinical trial. Participants and Intervention: Sixty-four eyes from 61 patients undergoing vitreoretinal surgery were randomized to receive either retrobulbar or sub-Tenon's capsule injection of 5 ml of a 50:50 mixture of 4{\%} lidocaine and 0.75{\%} bupivacaine. Main Outcome Measures: The primary outcome measured was intraoperative eye pain, which was rated by patients in both groups using an 11-point (0-10) numerical visual analogue scale immediately after surgery and again the next morning. The surgeons indicated whether they perceived patient discomfort during 4 different stages of the operation: opening of the conjunctiva, vitrectomy (if performed), placement of scleral buckle (if performed), and closing of the conjunctiva. The preincision time, need for supplemental local anesthesia, and use of IV sedation for additional pain control were compared between the two groups. Results: Thirty-four eyes were randomized to retrobulbar injections, and 30 eyes were randomized to sub-Tenon's capsule injections. There was no significant difference in patient-reported intraoperative pain scores between the retrobulbar and sub-Tenon's capsule groups when assessed immediately after surgery (median, 2.0 vs. 2.0; P = 0.52) or the next day (median, 2.0 vs. 1.0; P = 0.26). The surgeons reported no difference between the two groups in terms of the percentages of patients with pain during opening of the conjunctiva (20.6{\%} vs. 3.3{\%}; P = 0.058), vitrectomy (31{\%} vs. 32{\%}; P = 1.00), placement of scleral buckle (33.3{\%} vs. 40{\%}; P = 1.00), and closing of the conjunctiva (26.5{\%} vs. 26.7{\%}; P = 1.00). There was a suggestion that preincision time was longer in the sub-Tenon's capsule group. Approximately equal percentages of patients in each group required supplemental local anesthesia (38{\%} vs. 37{\%}; P = 0.90) or IV medication (85{\%} vs. 70{\%}; P = 0.14) for pain control. Conclusions: Sub-Tenon's capsule injection of local anesthetic seems as effective as retrobulbar injection at controlling intraoperative pain in vitreoretinal surgery.",
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AU - Lai, James C.

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AU - Huang, John J.

AU - Patel, Saurabh

AU - Ying, Howard S.

AU - Melia, Michele

AU - Haller, Julia A.

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N2 - Objective: To compare the efficacy and efficiency of retrobulbar versus sub-Tenon's capsule injection of local anesthetic in vitreoretinal surgery. Design: Prospective, randomized, double-masked clinical trial. Participants and Intervention: Sixty-four eyes from 61 patients undergoing vitreoretinal surgery were randomized to receive either retrobulbar or sub-Tenon's capsule injection of 5 ml of a 50:50 mixture of 4% lidocaine and 0.75% bupivacaine. Main Outcome Measures: The primary outcome measured was intraoperative eye pain, which was rated by patients in both groups using an 11-point (0-10) numerical visual analogue scale immediately after surgery and again the next morning. The surgeons indicated whether they perceived patient discomfort during 4 different stages of the operation: opening of the conjunctiva, vitrectomy (if performed), placement of scleral buckle (if performed), and closing of the conjunctiva. The preincision time, need for supplemental local anesthesia, and use of IV sedation for additional pain control were compared between the two groups. Results: Thirty-four eyes were randomized to retrobulbar injections, and 30 eyes were randomized to sub-Tenon's capsule injections. There was no significant difference in patient-reported intraoperative pain scores between the retrobulbar and sub-Tenon's capsule groups when assessed immediately after surgery (median, 2.0 vs. 2.0; P = 0.52) or the next day (median, 2.0 vs. 1.0; P = 0.26). The surgeons reported no difference between the two groups in terms of the percentages of patients with pain during opening of the conjunctiva (20.6% vs. 3.3%; P = 0.058), vitrectomy (31% vs. 32%; P = 1.00), placement of scleral buckle (33.3% vs. 40%; P = 1.00), and closing of the conjunctiva (26.5% vs. 26.7%; P = 1.00). There was a suggestion that preincision time was longer in the sub-Tenon's capsule group. Approximately equal percentages of patients in each group required supplemental local anesthesia (38% vs. 37%; P = 0.90) or IV medication (85% vs. 70%; P = 0.14) for pain control. Conclusions: Sub-Tenon's capsule injection of local anesthetic seems as effective as retrobulbar injection at controlling intraoperative pain in vitreoretinal surgery.

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