Expanding role of local anaesthesia in vitreoretinal surgery.
OBJECTIVE
Local anaesthesia (LA) is increasingly common in vitreoretinal surgery. However, younger patients often have such surgery under general anaesthesia (GA). We reanalysed the anaesthetic practice for vitreoretinal surgery in our unit over a 19-month period.


METHODS
A total of 1003 patients undergoing vitreoretinal surgery between August 2000 and February 2002 were studied. Type of surgery, patient pain score to anaesthesia and surgery, need for sedation and incidence of complications related to the local anaesthetic were recorded. Comparisons were made between this case series and previous data from our unit.


RESULTS
In total, 920/1003 (91.7%) patients had LA. Total operations comprised 418 vitrectomies, 518 retinopexies with or without vitrectomy and 67 buckling procedures. More patients under the age of 35 years had LA than previously (60.2 vs 35.7%, P<0.001). In 920/920 (100%) of cases, LA was administered via intraconal injection, compared to 164/1221 (13.4%) of procedures previously. Significantly more patients under the age of 35 years required sedation (35.9%) than did older patients (19.2%). Overall, use of sedation was significantly increased since our previous study (20.2 vs 7.8%). Anaesthesia and surgery were well tolerated by patients. There were no cases of orbital haemorrhage or ocular perforation. Complications included bradycardia requiring atropine 1/920 (0.1%) and chemosis 88/920 (9.6%).


CONCLUSIONS
LA is well tolerated and effective even in younger patients. Sedation may well be required in younger patients and for procedures involving scleral buckling. The main indication for GA was patient preference. Despite this, such patients accounted for only 5.2% of the total.
Costen
M T J
MT
Southampton Eye Unit, Southampton General Hospital, Southampton, UK. mtcosten@doctors.org.uk
Newsom
R S
RS
Wainwright
A C
AC
Luff
A J
AJ
Canning
C R
CR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D016292:Procedural Sedation / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D004739:England; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain; D011364:Professional Practice / Q000706:statistics & numerical data; D011446:Prospective Studies; D012160:Retina / Q000601:surgery*; D012591:Scleral Buckling; D014821:Vitrectomy
D000779:Anesthetics, Local