Topical versus peribulbar anesthesia in non-penetrating deep sclerectomy. A cost-effectiveness analysis.

AIM: To assess the costs and cost-effectiveness ratio of topical and peribulbar anesthesia in non-penetrating deep sclerectomy for the surgical treatment of open-angle glaucoma. PATIENTS AND METHODS: We evaluated the associated direct costs with both topical and peribulbar anesthesia. Effectiveness was defined as the proportion of patients that experienced no pain during the surgical procedure and was obtained from the literature. Cost-effectiveness was defined as direct cost of anesthesia per patient with no pain. We also calculated the incremental cost-effectiveness ratio (ICER) in order to determine which intervention was dominant. RESULTS: Direct costs were US$ 45.60 and US$ 49.18 for topical and peribulbar anesthesia respectively. The great majority of patients experienced no pain with any of the procedures (91.7% for the topical group and 69.7% for the peribulbar group). Cost-effectiveness ratio was US$ 49.73 for topical anesthesia and US$ 70.56 for peribulbar anesthesia. The ICER was negative and topical anesthesia was dominant over peribulbar anesthesia. CONCLUSION: Topical anesthesia was less costly and more effective than peribulbar anesthesia in avoiding pain in non-penetrating deep sclerectomy.

[Anesthesia in glaucoma surgery]. / L'anesthésie dans la chirurgie du glaucome.

Various types of anesthesia, as well as different surgical techniques are available in glaucoma surgery. This study's purpose is to review and update the different possibilities of anesthesia according to the various types of surgical procedures in glaucoma. The different types of anesthesia for glaucoma surgery are general anesthesia, local anesthesia or topical anesthesia. In children, general anesthesia has an absolute indication, whatever the surgical procedure to be used. In adults, literature demonstrates that local anesthesia (retrobulbar or peribulbar) is the most frequently used technique. There is a growing interest in topical anesthesia, which has brought many advantages, for glaucoma surgery (trabeculectomy, deep sclerectomy, aqueous shunt surgery and combined procedures). Choice among the different modalities of anesthesia has to be done according to various parameters based on both patient and surgeon point of view. A close link between surgeon and anesthesiologist is of an utmost importance to ensure the most efficient, comfortable, and appropriate anesthesia for each individual patient.