RESUMO
Periconal local anaesthesia with subtenon supplementation was used to provide anaesthesia for 94 patients having vitreoretinal surgery. Of these, 44 patients also received general anaesthesia with neuromuscular block. None of these patients received opioid or antiemetic before or during surgery. In comparison with a retrospective control group, patients who had received local anaesthesia as part of their anaesthetic technique were less likely to be given a parenteral opioid (P < 0.001) or to vomit (P < 0.001) within six hours of the completion of surgery. They also experienced significantly fewer bradycardic episodes during surgery (P = 0.001). For patients having general anaesthesia, administration of an intraoperative antiemetic reduced the incidence of vomiting within six hours of the completion of surgery (P = 0.008). For patients who did not receive local anaesthetic, shorter operating time was a factor associated with both reduced postoperative vomiting (P = 0.0015) and administration of parenteral opioid (P = 0.0014). It is suggested that the use of local anaesthesia as part of the anaesthetic technique for vitreoretinal surgery is associated with improved patient comfort.
Assuntos
Anestesia Local , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Retina/cirurgia , Corpo Vítreo/cirurgia , Vômito/prevenção & controle , Analgésicos Opioides/administração & dosagem , Anestesia Geral , Antieméticos/administração & dosagem , Antieméticos/uso terapêutico , Bradicardia/prevenção & controle , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/prevenção & controle , Incidência , Infusões Parenterais , Cuidados Intraoperatórios , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Estudos Prospectivos , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Recurvamento da Esclera , VitrectomiaRESUMO
A series of 13 cases of globe perforation following local ocular anaesthesia are reported. All cases were associated with cataract surgery. Perforation occurred with the retrobulbar approach in nine cases and with the peribulbar approach in two cases. In two cases the approach for local anaesthesia was not recorded. In 12 of the 13 cases, a perforating wound was found in the inferotemporal quadrant. All cases were found to have vitreous haemorrhage. All cases had significant posterior segment injury. Vitrectomy was carried out in nine of the 13 cases. At final review the retina was attached in 12 of the 13 cases. A final visual acuity of between 6/9 and 6/12 was achieved in six cases, four cases had acuity of between 6/18 and 6/24 and three cases had a visual result of less than 6/60.