title: Vitreoretinal surgery: pre-emptive analgesia.
abstract: OBJECTIVE
  Vitrectomies are performed either under general anesthesia (GA), local anesthesia (LA), or a combination of both. Postoperative pain is expected to be less in patients with LA because of prolonged action of the local anaesthetic. Pre-emptive analgesia is based on the idea that analgesia initiated before a nociceptive event will be more effective than analgesia commenced afterwards. The authors compared postoperative analgesia in patients with GA combined with preoperative or postoperative LA.
  
  
  METHODS
  90 patients scheduled for vitrectomy without buckling were enrolled in the study. 60 patients underwent GA, 30 without LA, 15 with preoperative LA, and 15 with postoperative LA. 30 patients received LA alone. Subjective postoperative pain was determined using the visual analogue scale.
  
  
  RESULTS
  Postoperative pain was less under LA alone compared to GA alone (p < 0.0001). Additional preoperative application of LA resulted in less pain than additional postoperative application (p <0.05). Additional postoperative peribulbar aneasthesia did not differ from GA alone.
  
  
  CONCLUSIONS
  The authors conclude that LA alone or preoperatively in addition to GA provides the best comfort for the patient in vitreoretinal surgery.
authors.affiliation: Klinikum Innenstadt, Mathildenstrasse 8, D-80336 Munich, Germany. n.kristin@ak-i.med.uni-muenchen.de
authors.forename: N
authors.initials: N
authors.lastname: Kristin
authors.forename: C L
authors.initials: CL
authors.lastname: Schönfeld
authors.forename: M
authors.initials: M
authors.lastname: Bechmann
authors.forename: M
authors.initials: M
authors.lastname: Bengisu
authors.forename: K
authors.initials: K
authors.lastname: Ludwig
authors.forename: A
authors.initials: A
authors.lastname: Scheider
authors.forename: A
authors.initials: A
authors.lastname: Kampik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D018709:Statistics, Nonparametric; D014821:Vitrectomy / Q000379:methods*