title: Subconjunctival versus peribulbar anesthesia in trabeculectomy: a prospective, randomized study.
abstract: OBJECTIVE
  To compare the use of subconjunctival and peribulbar anesthesia for trabeculectomy.
  
  
  METHODS
  Sixty patients undergoing trabeculectomy were prospectively randomized to receive either peribulbar or subconjunctival anesthesia. Peribulbar anesthesia consisted of a 3-ml inferior and a 1-ml superior injection of a 1:1 mixture of 2% mepivacaine, 0.75% bupivacaine, and hyaluronidase. Subconjunctival anesthesia consisted of a 1- to 2-ml injection of the same mixture without hyaluronidase in the superotemporal quadrant. Intraoperative pain, presence of eye movements, and complications during surgery were evaluated.
  
  
  RESULTS
  The frequency and intensity of pain was statistically similar between the two groups. All episodes of pain (20% in the subconjunctival group and 6.6% in the peribulbar group) were rated as mild. Eye movement was more common in the subconjunctival group than in the peribulbar group, but it was controlled by verbal command and did not interfere with the procedure. No clinically significant complications occurred during surgery.
  
  
  CONCLUSIONS
  Subconjunctival anesthesia is an effective alternative to peribulbar anesthesia for trabeculectomy.
authors.affiliation: Glaucoma Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA 19107, USA.
authors.forename: A
authors.initials: A
authors.lastname: Azuara-Blanco
authors.forename: M R
authors.initials: MR
authors.lastname: Moster
authors.forename: B P
authors.initials: BP
authors.lastname: Marr
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D003228:Conjunctiva; D004338:Drug Combinations; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007267:Injections; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D009915:Orbit; D011446:Prospective Studies; D014130:Trabeculectomy
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D008619:Mepivacaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine