title: Preoperative sub-Tenon's capsule injection of ropivacaine in conjunction with general anesthesia in retinal detachment surgery.
abstract: OBJECTIVE
  To evaluate the effects of preoperative sub-Tenon's capsule injection of ropivacaine on intraoperative hemodynamics, postoperative pain, nausea, and recovery in patients undergoing scleral buckling surgery under general anesthesia (GA).
  
  
  METHODS
  Randomized double-masked controlled clinical trial.
  
  
  METHODS
  Ninety-eight patients with primary rhegmatogenous retinal detachment undergoing scleral buckling surgery under GA.
  
  
  METHODS
  Random allocation to either preoperative sub-Tenon's capsule injection of 3 ml of 0.75% ropivacaine or sub-Tenon's capsule injection of 3 ml of saline (controls) immediately before a scleral buckling procedure under GA. Intraoperative monitoring of hemodynamic parameters, need of analgesia with sevoflurane and alfentanil, time in the recovery unit, measurements of pain and nausea on the visual analog scale (VAS) up to 12 hours postoperatively, and consumption of analgesics and antiemetics was recorded.
  
  
  METHODS
  Intraoperative systolic blood pressure (BP); bradycardia; minimum alveolar concentration (MAC) of sevoflurane; maximum postoperative VAS scores of pain and nausea; time in recovery unit; and total need of alfentanil, ketobemidone, dextropropoxyphene, and dixyrazine.
  
  
  RESULTS
  Ninety-seven patients were analyzed (48 in the ropivacaine group and 49 controls). A significantly lower intraoperative systolic BP (104+/-6 vs. 112+/-7 mmHg; P = 0.004), less need of sevoflurane (1.33+/-0.19 vs. 1.56+/-0.23; P = 0.03), and shorter time in the recovery unit (67+/-9 vs. 76+/-16 minutes; P = 0.01) were observed in the ropivacaine group. Maximum VAS pain scores were 50+/-21 in the control group and 36+/-25 in the ropivacaine group (P = 0.05), with a significantly lower consumption of opioids (ketobemidone) in the ropivacaine group (3.6+/-3.5 vs. 1.3+/-2.0 mg). No significant difference was observed regarding nausea or need of dixyrazine or dextropropoxyphene postoperatively.
  
  
  CONCLUSIONS
  Preoperative sub-Tenon's capsule injection of ropivacaine in scleral buckling surgery under GA lowers the intraoperative systolic BP, reduces the amount of inhalable sevoflurane needed, and enhances postoperative vigilance through reduction of pain and need of opioids.
authors: Department of Vitreoretinal Diseases, St. Erik's Eye Hospital, Stockholm, Sweden. louise.bergman@sankterik.se
authors: Louise
authors: L
authors: Bergman
authors: Ingrid
authors: I
authors: Bäckmark
authors: Håkon
authors: H
authors: Ones
authors: Christopher
authors: C
authors: von Euler
authors: Göran
authors: G
authors: Olivestedt
authors: Anders
authors: A
authors: Kvanta
authors: Björn
authors: B
authors: Stéen
authors: Stefan
authors: S
authors: Seregard
authors: Bo
authors: B
authors: Nilsson
authors: Lennart
authors: L
authors: Berglin
mesh_terms: D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000932:Antiemetics / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology; D003238:Connective Tissue / Q000187:drug effects; D011431:Dextropropoxyphene / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000503:physiopathology; D010149:Postoperative Pain; D010640:Phenothiazines / Q000008:administration & dosage; D011300:Preoperative Care; D012163:Retinal Detachment / Q000503:physiopathology / Q000601:surgery*; D000077212:Ropivacaine; D012591:Scleral Buckling
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000932:Antiemetics; D010640:Phenothiazines; C012950:dixyrazine; D000077212:Ropivacaine; D011431:Dextropropoxyphene