Postoperative analgesia by reinjections of local anesthetic through an indwelling retrobulbar catheter

doi:10.1016/S0002-9394(99)00256-1

American Journal of Ophthalmology

Volume 129, Issue 1, January 2000, Pages 54-58

https://doi.org/10.1016/S0002-9394(99)00256-1 Get rights and content

Abstract

PURPOSE:

To evaluate an indwelling retrobulbar catheter for repeatable postoperative retrobulbar injections of local anesthetics for titratable analgesia after intraocular surgery.

METHODS:

The prospective study included all 124 patients (124 eyes) who consecutively underwent retinal or cyclocryocoagulation (n = 22), pars plana vitrectomy, or retinal detachment surgery (n = 102), and who were operated on by the same surgeon with local anesthesia within a period of 12 months. Using commercially available retrobulbar needles with a diameter of 0.60 mm or 0.80 mm and a length of 38 mm, 5 ml of mepivacaine 2% with hyaluronidase were injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place. When the patients started to feel pain after surgery, 2 ml of mepivacaine 2% or 2 ml of bupivacaine 0.75% were reinjected through the catheter. The catheter was removed 24 to 72 hours after surgery.

RESULTS:

Because of increasing pain in the postoperative period, 93 patients (93 of 124, or 75%) received a reinjection 4.2 ± 2.0 hours after the preoperative injection. Seventy patients received a second reinjection after an additional 2.7 ± 1.9 hours, and 42 patients received a third reinjection 3.1 ± 2.0 hours later. After each reinjection, the patients became pain free. Removal of the catheter after surgery was unremarkable.

CONCLUSIONS:

An indwelling retrobulbar catheter for repeatable postoperative injection of short-acting local anesthetics is useful and effective for titratable postoperative analgesia after intraocular surgery, and it allows patients to avoid the side effects of systemic analgesics and sedatives.

Section snippets

Patients and methods

One hundred twenty-four patients (61 women, 63 men; 54 right eyes, 70 left eyes) were included in the study. Mean age was 66.43 ± 10.14 years (mean ± SD; range, 35 to 91 years). The patients underwent cyclocryocoagulation and retinal cryocoagulation for proliferative retinopathy with neovascularization of the iris and secondary angle-closure glaucoma (n = 22), scleral buckling procedures with retinal exocryocoagulation for rhegmatogenous retinal detachment (n = 22), cataract surgery, and

Results

In the postoperative period, 4.2 ± 2.0 hours (mean ± SD) after the preoperative injection, 93 patients (93 of 124 or 75%) asked for a reinjection of the local anesthetic after which they were pain free again, according to grade 0 to 2 on the pain scale. Seventy patients demanded a second reinjection after additional 2.7 ± 1.9 hours (2.2 ± 1.4 hours for the group administered mepicavaine 2% [n = 39 patients]; 3.3 ± 2.4 hours for the group administered bupivacaine 0.75% [n = 30 patients]), and 42

Discussion

Local anesthesia is generally regarded as preferable to general anesthesia for many surgical interventions in ophthalmology.2 After relatively long procedures, such as some pars plana vitrectomies, however, the effect of the anesthetic agent injected retrobulbarly diminishes with time. This can cause discomfort and pain for the patient as soon as the first hour after the end of the operation. Correspondingly, patients undergoing short procedures with marked tissue destruction, such as

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Supplementation of retrobulbar block with clonidine in vitreoretinal surgery: Effect on postoperative pain
2011, Journal of Clinical Anesthesia
Citation Excerpt :
Furthermore, epinephrine may potentiate myotoxicity of local anesthetics [9]. Postoperative analgesia extending beyond the duration of a long-acting local anesthetic such as ropivacaine or bupivacaine may be achieved by a continuous local anesthetic technique with the insertion of a catheter into the retrobulbar or peribulbar space [4,10]. However, many ophthalmic surgeons are reluctant to use continuous catheter techniques postoperatively.
To evaluate the effect of clonidine when added to local anesthetics on duration of postoperative analgesia during retrobulbar block.
Prospective, randomized controlled trial.
Operating room and Postanesthesia Care Unit of a university-affiliated hospital.
80 ASA physical status 1, 2, and 3 patients undergoing vitreoretinal surgery with or without scleral buckling.
Patients in the control group (n = 40) received a retrobulbar block with 4.5 mL of lidocaine-bupivacaine and 0.5 mL of saline. Clonidine group patients (n = 40) received 4.5 mL of lidocaine-bupivacaine and 0.5 μg/kg of clonidine in a 0.5 mL volume.
The time to first analgesic request, frequency of postoperative pain, and number of postoperative analgesic requests per patient were assessed.
37 patients in the control group (92.5%) versus 24 patients (60%) in the clonidine group reported pain postoperatively (P = 0.001), with a shorter time to first analgesic request noted in the control group (4.9 ± 3 vs 11.9 ± 5.3 hrs; P < 0.001). The median number of postoperative analgesic requests per patient during the first 24 hours was higher in the control group than the clonidine group [2 (0-3) vs. 1 (0-3); P < 0.001].
The addition of clonidine 0.5 μg/kg to the local anesthetics of a retrobulbar block for vitreoretinal surgery decreases the frequency of postoperative pain and prolongs the time of analgesia.
Postoperative analgesia with a transcutaneous parabulbar butterfly catheter
2008, Canadian Journal of Ophthalmology
Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative diabetic retinopathy
2001, American Journal of Ophthalmology
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Pars plana vitrectomy, including membrane peeling and retinal endolasercoagulation, was carried out with general anesthesia in five of the 29 patients (17.2%). The remaining 24 of the 29 patients (82.8%) underwent surgery with local anesthesia using the retrobulbar catheter technique for prolonged local anesthesia and postoperative analgesia by repeatable retrobulbar injections of the anesthetics through the catheter.14 Ten of the 29 patients (34.5%) were pseudophakic or aphakic before pars plana vitrectomy.
PURPOSE: To report the clinical outcome and complications of intravitreal injections of crystalline cortisone in patients undergoing pars plana vitrectomy for treatment of proliferative diabetic retinopathy.
METHODS: The prospective, interventional case series study included 29 consecutive patients (29 eyes) who underwent pars plana vitrectomy for treatment of complicated proliferative diabetic retinopathy associated with central retinal traction detachment. All patients received an intravitreal injection of 15 to 20 mg of crystalline triamcinolone acetonide at the end of surgery, and were operated on by the same surgeon. Mean follow-up time was 1.4 ± 1.1 months (median, 1 month; range, 0.30 to 4.9 months).
RESULTS: At the end of the follow-up period, the retina was attached in 26 of the 29 patients (89.7%). In three of the 29 patients (10.3%), a retinal redetachment had occurred. None of the patients developed iris neovascularization, and the iris neovascularization, present preoperatively in 12 patients, slightly to markedly regressed in all 12 patients. Preoperative and postoperative intraocular pressure values (P = .72) and blood glucose measurements did not vary significantly. A pseudohypopyon consisting of cortisone crystals in the inferior anterior chamber angle was detected in one patient and resolved spontaneously within 4 days.
CONCLUSIONS: The present clinical study suggests that intravitreal injection of crystalline cortisone with most of the vehicle removed seems to be well tolerated by eyes undergoing pars plana vitrectomy for treatment of complicated diabetic proliferative retinopathy. In view of the antiphlogistic and antiproliferative effect of cortisone, future randomized clinical trials may be indicated to investigate further the role of intravitreal injection of crystalline cortisone in the treatment of proliferative diabetic retinopathy.
The retrospective comparison of Sub-Tenon block techniques for prolonged vitreoretinal surgery
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^☆: This study was supported by Deutsche Forschungsgemeinschaft DFG (grant SFB 539), Bonn, Germany (Drs Jonas and Budde).

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Postoperative analgesia by reinjections of local anesthetic through an indwelling retrobulbar catheter☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Ophthalmology

Surv Ophthalmol

Ophthalmology

Br J Anaesth

Br J Anaesth

J Cataract Refract Surg

A comparison of retrobulbar and periocular anesthesia for cataract surgery

Arch Ophthalmol

Globe perforation from peribulbar injection

Arch Ophthalmol

Retrobulbar anesthesia with a flexible catheter

Ophthalmic Surg Lasers