Article Text

Download PDFPDF
Original article
Two-quadrant high-volume sub-Tenon's anaesthesia for vitrectomy: a randomised controlled trial
  1. Vip S Gill1,
  2. Andrew H Presland2,
  3. Jonathan A Lord2,
  4. Catey Bunce2,
  5. Wen Xing2,
  6. David G Charteris2
  1. 1Department of Anaesthesia, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
  2. 2Department of Anaesthesia, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Vip S Gill, Department of Anaesthesia, Guy's and St Thomas' Hospital NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK; drvipgill{at}


Background Total volume using a standard single inferonasal injection for sub-Tenon's anaesthesia is limited by an increase in intraocular pressure (IOP) and commonly requires the operating surgeon to top-up the block intraoperatively. This study compares the efficacy and safety of a two-quadrant technique that allows the use of a higher volume of local anaesthetic.

Methods 54 patients undergoing vitrectomy were randomised into two groups. The control group (n=27) received a standard 5 ml single inferonasal sub-Tenon injection of a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine with 150 IU hyaluronidase. The study group (n=27) received a 5 ml inferonasal and 5 ml superotemporal injection of the same mixture (10 ml total). The primary outcome measure was the number of intraoperative top-ups required. Secondary outcome measures were intraoperative and postoperative pain scores, IOP, block onset time, ocular akinesia, eyelid akinesia and chemosis.

Results 24 patients required a top-up in the control group. No patients required a top-up in the study group (p<0.001). IOP measurements were similar in both groups. Block onset was shorter, eyelid akinesia was improved and pain scores were also reduced in the study group intraoperatively and at 0–2 h, 4–6 h, 10–14 h and 20–24 h postoperatively.

Conclusions Two-quadrant sub-Tenon's anaesthesia using 10 ml of a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine with 150 IU hyaluronidase seems to be more effective than a single-quadrant technique at reducing intraoperative and postoperative pain during vitrectomy.

  • Sub-Tenon's anaesthesia
  • clinical trial
  • local anaesthetics
  • vitreoretinal surgery
  • intraocular pressure
  • posterior chamber
  • retina
  • pharmacology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was funded by Moorfields Eye Hospital NHS Foundation Trust.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Moorfields & Whittington Hospitals Local Research Ethics Committee (NHS REC Ref: 08/H0721/33).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • At a glance
    Harminder S Dua Arun D Singh