Retrobulbar catheter technique for postoperative titratable analgesia after glaucoma surgery.
OBJECTIVE
To assess an indwelling retrobulbar catheter for delivery of intraoperative anesthesia and postoperative analgesia in patients undergoing painful cyclodestructive and retinal destructive procedures as treatment of neovascular glaucoma.


METHODS
The prospective clinical interventional study included all 11 patients undergoing cyclocryocoagulation and/or retinal exocryocoagulation as treatment of neovascular glaucoma due to proliferate ischemic retinopathies. Using a commercially available retrobulbar needle with a diameter of 0.80 mm and a length of 38 mm, 7 mL of a local anesthetic 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needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place.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 began to feel pain during or after surgery, 2 mL of a local anesthetic were reinjected through the catheter. The catheter was removed 24 hours after surgery.


RESULTS
Due to increasing pain in the postoperative period, 8 (72.7%) patients received a reinjection 156.3 +/- 94.6 minutes after the preoperative injection. Seven (63.6%) patients requested a second reinjection 268.6 +/- 45.7 minutes after the preoperative injection, and three (27.3%) patients requested a third postoperative injection 333.3 +/- 79.1 minutes after the preoperative injection. Reinjection of the local anesthetic through the catheter markedly decreased the pain within 5 minutes of injection in all patients.


CONCLUSIONS
Avoiding side effects of systemic analgesics and sedatives, an indwelling retrobulbar catheter for repeat postoperative injections of local anesthetics is useful and effective for titratable postoperative analgesia after painful cyclodestructive or retinal destructive surgery as treatment of neovascular glaucoma.
Jäger
Melanie
M
Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Hemmerling
Thomas
T
Jonas
Jost B
JB
D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002404:Catheterization / Q000379:methods; D002408:Catheters, Indwelling; D002924:Ciliary Body / Q000601:surgery; D003452:Cryosurgery; D005260:Female; D015355:Glaucoma, Neovascular / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D008875:Middle Aged; D009915:Orbit; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012164:Retinal Diseases / Q000150:complications / Q000601:surgery
D000779:Anesthetics, Local; D008619:Mepivacaine