Expanding role of local anaesthesia in vitreoretinal surgery

Costen, M T J; Newsom, Richard; Wainwright, A.C.; Luff, A J; Canning, C R

doi:10.1038/sj.eye.6701640

Cited by 36 publications

(31 citation statements)

References 12 publications

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“…Although the scale of visual perceptions is well documented during cataract surgery, [1][2][3][4][5][6] the extent of these experiences during vitreoretinal surgery is less well known. 7,8 As vitreoretinal procedures are increasingly being performed under LA, 9 and appear well tolerated by the patient, 10 it is vital that we adequately and appropriately inform patients of what they might experience during the surgery.…”

Section: Introductionmentioning

confidence: 99%

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

Vohra

Anya

Farooq

et al. 2008

Eye

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Purpose To evaluate the visual experiences of patients during vitreoretinal surgery under local anaesthesia (LA). Methods Prospective questionnaire survey of 80 patients within 30 min of completion of vitreoretinal surgery under LA. Preoperative visual acuity, surgical procedure and its duration, efficacy of the local block, as well as intraoperative perceptions of flashes, colours, movements, and seeing instruments were documented. Results A sub-Tenon's block was performed in 62/80 (77.5%) and a peribulbar block in the remainder. Overall, 72 (90%) of patients perceived light at some stage during their surgery. Of these, 51 (70.83%) observed movements, 45 (62.5%) saw colours, 38 (52.77%) saw instruments, and 24 (33.33%) saw flashes. The commonest observations were colourful swirls, black pipes, and the colour red. Most patients found these experiences pleasant or bearable; two found them frightening, and four would like to have been warned preoperatively about them. Preoperative visual acuity, diagnosis, gender of the patient, degree of akinesia, and the duration of surgery did not associate with visual perceptions. Logistic regression analysis showed that younger people were more likely to experience flashing lights (P ¼ 0.03) and to see instruments (P ¼ 0.04), patients having a sub-Tenon's block to perceive light (P ¼ 0.005), and those who did not receive awake sedation were more likely to see instruments (P ¼ 0.04). Conclusions Visual experiences are common during vitreoretinal surgery undertaken under LA. Where appropriate, patients should be forewarned about these experiences and reassured that they are not normally frightening.

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Section: Introductionmentioning

confidence: 99%

Subjective visual perceptions during vitreoretinal surgery under local anaesthesia

Vohra

Anya

Farooq

et al. 2008

Eye

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“…Only 6% of patients (39/518) undergoing retinopexy (with or without vitrectomy) had GA. 1 This therefore has little effect on our reported LA rate, as suggested by Gray et al Our previous work involved taking the opinion of the patient, who being recovered by the anaesthetist, had no preconceived surgical opinion on what does or does not hurt. We found that the laser and cryopexy were more important determinants of discomfort during vitrectomy than other aspects of the surgery, and so these were analysed as one group.…”

Section: Reply To Gray Et Almentioning

confidence: 60%

Reply to Gray et al

Costen

2006

Eye

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“…1 We are aware that subtenons anaesthesia is used for VR surgery; 2 however, to achieve a rate of 87%, under local anaesthesia, is certainly impressive. The authors are not clear on their own use of sedation.…”

Section: Sir Response To Goldsmith Et Almentioning

confidence: 99%

“…[1][2][3][4] This is an ongoing debate and has been discussed in This Journal before. 5 The first fallacy that needs to be highlighted is about the urgency of management of macula-on detachments.…”

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confidence: 99%