Subtenon block combined with general anesthesia for vitreoretinal surgery improves postoperative analgesia in adult: a randomized controlled trial

Abouammoh, Marwan; Abdelhalim, Ashraf Arafat; Mohamed, Elsyed A.; Elzoughari, Ismail; Mustafa, M. A.; Alzahrani, Tariq

doi:10.1016/j.jclinane.2015.11.013

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…Moreover, sub-Tenon's levobupivacaine leads to the decreased requisite of postoperative analgesics, decreased incidence of OCR, and better surgeon satisfaction. These findings are similar to that of Abouammoh et al [7] who reported that the combination of sub-Tenon's block and general anesthesia reduced postoperative analgesic requirements and complications.…”

Section: Discussionsupporting

confidence: 91%

Postoperative analgesic efficacy of sub-Tenon's block with levobupivacaine in retinal surgery under general anesthesia

2019

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Background:Vitreoretinal surgery is associated with undesirable intraoperative and postoperative complications including pain, postoperative nausea and vomiting, and oculocardiac reflex (OCR). Systemic analgesics have side effects and are contraindicated in some cases. We hypothesized that the preoperative sub-Tenon's injection of levobupivacaine with general anesthesia would decrease postoperative pain and intraocular pressure as well as the incidence of complication.Methods:Eighty patients who were presented for vitreoretinal surgery, aged 30–60 years, were enrolled in the study. General anesthesia was administrated to all patients; then, they were randomized into two equal groups (40 each) – Group I: patients received 5 mL placebo solution for sub-Tenon's block and Group II: patients received 4 mL levobupivacaine 0.5% in 1 mL saline for sub-Tenon's block. Postoperative pain was evaluated using a verbal pain scale. Surgeon satisfaction, postoperative analgesic consumption, and perioperative hemodynamics were also reported.Results:Verbal rating pain scores were significantly lower at the first 6 h postoperative in Group II (sub-Tenon's levobupivacaine) compared to Group I (sub-Tenon's placebo). First analgesic rescue time and total dose of analgesic consumption were significantly reduced in Group II compared to Group I. There was a lower incidence of OCR with sub-Tenon's levobupivacaine (Group II), also surgeon satisfaction was significantly superior in the same group.Conclusion:The combination of general anesthesia with sub-Tenon's block using levobupivacaine in retinal surgery patients reduces pain scores after surgery; total analgesia requirement also decreases the incidence of OCR.

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Section: Discussionsupporting

confidence: 91%

Postoperative analgesic efficacy of sub-Tenon's block with levobupivacaine in retinal surgery under general anesthesia

2019

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“…Nausea was defined as subjective sensation of discomfort associated with awareness of the urge to vomit, whereas Vomiting was defined as a forceful expulsion of gastric contents through the mouth, as in the report of Abouammoh MA et al [ 26 ]. In cases of PONV, ondansetron 4 mg (Ondansetron Accord, Accord Healthcare Limited, UK) [ 24 ] was administered intravenously as the therapy of choice, or as an alternative, to meet the patients’ individual needs, according to contemporary guidelines [ 27 ]. Optylite solution 5 mL/kg was infused in cases of MAP < 65 mmHg.…”

Section: Methodsmentioning

confidence: 99%

Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

Pluta

Stasiowski

Lyssek-Boroń

et al. 2021

JCM

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The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV.

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“…The initial electronic database search yielded 1501 articles after removal of duplicates, with 36 studies selected for full-text review (see Figure 1 for a PRISMA flow diagram). Excluded were 3 non-RCTs, 6,10,11 6 not full-length articles, 12 –17 1 article published before 1990, 18 16 studies with vitreoretinal surgery for other causes than retinal detachment, 19 –34 and 2 articles without vitreoretinal surgery. 35,36 The 8 remaining articles were included in this systemic review.…”

Section: Resultsmentioning

confidence: 99%

“…It is generally accepted that a regional anesthetic block at the end of the procedure affords better pain relief in the postoperative period. 4,19,65 As only a single study included in this systemic review reported the use of regional anesthesia alone, further study is required to address this knowledge gap.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Pain Management in Vitreoretinal Surgery for Retinal Detachment: A Systematic Review of Randomized Controlled Trials

Massicotte

Hammamji

Landry

et al. 2018

Journal of VitreoRetinal Diseases

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The purpose of this study is to examine the evidence for postoperative pain management in patients undergoing vitreoretinal surgery for retinal detachment by systematic review. Methods: A systematic review of the literature was performed using multiple databases in July 2016 and September 2017. Two independent reviewers screened titles and abstracts and analyzed selected papers in detail. Included studies assessed patients undergoing vitreoretinal surgery for retinal detachment and described postoperative pain management. Risk of bias was assessed using the criteria outlined in the "risk of bias" tool in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Nine randomized controlled studies comprising 517 patients met the inclusion criteria. Pain management included perioperative peribulbar, sub-Tenon, and retrobulbar anesthetic block; perioperative systemic anti-inflammatory and postoperative systemic and topical anti-inflammatory drugs; and ice compress. Pain scores were assessed with nominal, numerical, and visual analog scales. Risk of bias was low for 2 studies, unclear for 4 studies, and high for 3 studies. All studies reported better postoperative pain scores with the active treatment group except for a single study comparing retrobulbar chirocaine with and without clonidine. No serious adverse events were reported for any of the studies. Conclusion: Heterogeneity of studies did not allow for meta-analysis, but qualitative analysis suggests that pain relief can be achieved in the short term with a variety of treatment interventions. Additional study is required to specifically examine pain management strategies according to the characteristics of the anesthesia and surgery as well as the needs of the patient.

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Subtenon block combined with general anesthesia for vitreoretinal surgery improves postoperative analgesia in adult: a randomized controlled trial

Cited by 13 publications

References 30 publications

Postoperative analgesic efficacy of sub-Tenon's block with levobupivacaine in retinal surgery under general anesthesia

Postoperative analgesic efficacy of sub-Tenon's block with levobupivacaine in retinal surgery under general anesthesia

Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

Postoperative Pain Management in Vitreoretinal Surgery for Retinal Detachment: A Systematic Review of Randomized Controlled Trials

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