title: [Additive retrobulbar anesthesia in surgery of retinal detachment with general anesthesia. Reduced postoperative pain and stress response].
abstract: BACKGROUND
  It has recently been shown that the pain occurring after retinal detachment surgery can be reduced by combined general and retrobulbar anesthesia. This study investigated the effect of retrobulbar anesthesia on the intra- and postoperative stress response and on postoperative pain, vigilance, nausea and vomiting.
  
  
  METHODS
  In this prospective randomized study, 45 patients were enrolled where scleral buckling surgery for retinal detachment had been performed under general anesthesia. Bupivacain 0.5% (4 ml) was injected retrobulbarly in group I (n = 15) before surgery (preoperative) and in group II (n = 15) after surgery (postoperative), group III did not receive retrobulbar anesthesia. At different times during and after surgery, blood pressure, cortisol and glucose levels, time in the recovery unit, vigilance score, nausea and vomiting were measured and the pain score was determined. The dosages of intraoperative opioid analgetics and of postoperative pain medication were documented.
  
  
  RESULTS
  Retrobulbar anesthesia reduces postoperative pain. Intra- and postoperative endogenous stress responses in groups I and II were reduced and the plasma levels of cortisol and glucose in group I were lower than in group II. In group I, nausea, dosages of intraoperative opioid analgetics and postoperative pain medication were reduced, the vigilance was increased and time in the recovery unit was shortened.
  
  
  CONCLUSIONS
  The data show that combined local and general anesthesia has several advantages over general anesthesia alone, especially when the retrobulbar injection is given before retinal detachment surgery.
authors.affiliation: Abteilung für Anaesthesie, Evangelisches Krankenhaus, Mülheim, Münster.
authors.forename: C
authors.initials: C
authors.lastname: Kawohl
authors.forename: A
authors.initials: A
authors.lastname: Heiligenhaus
authors.forename: M
authors.initials: M
authors.lastname: Heiden
authors.forename: W
authors.initials: W
authors.lastname: Strunk
authors.forename: C C
authors.initials: CC
authors.lastname: Lösche
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001786:Blood Glucose / Q000378:metabolism; D002045:Bupivacaine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D012163:Retinal Detachment / Q000601:surgery*; D012591:Scleral Buckling
chemical_list: D001786:Blood Glucose; D006854:Hydrocortisone; D002045:Bupivacaine