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. 2001 Nov;85(11):1328–1331. doi: 10.1136/bjo.85.11.1328

Vitreoretinal surgery: pre-emptive analgesia

N Kristin 1, C Schonfeld 1, M Bechmann 1, M Bengisu 1, K Ludwig 1, A Scheider 1, A Kampik 1
PMCID: PMC1723785  PMID: 11673300

Abstract

AIM—Vitrectomies are performed either under general anesthesia (GA), local anesthesia (LA), or a combination of both. Postoperative pain is expected to be less in patients with LA because of prolonged action of the local anaesthetic. Pre-emptive analgesia is based on the idea that analgesia initiated before a nociceptive event will be more effective than analgesia commenced afterwards. The authors compared postoperative analgesia in patients with GA combined with preoperative or postoperative LA.
METHODS—90 patients scheduled for vitrectomy without buckling were enrolled in the study. 60 patients underwent GA, 30 without LA, 15 with preoperative LA, and 15 with postoperative LA. 30 patients received LA alone. Subjective postoperative pain was determined using the visual analogue scale.
RESULTS—Postoperative pain was less under LA alone compared to GA alone (p < 0.0001). Additional preoperative application of LA resulted in less pain than additional postoperative application (p <0.05). Additional postoperative peribulbar aneasthesia did not differ from GA alone.
CONCLUSION—The authors conclude that LA alone or preoperatively in addition to GA provides the best comfort for the patient in vitreoretinal surgery.



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Figure 1  .

Figure 1  

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The postoperative pain score was assessed using the visual analogue scale (VAS) 1, 3, and 24 hours after surgery. Group A: general anaesthesia (GA); group B: retrobulbar local anaesthesia (LA); group C: GA and preoperative peribulbar LA; group D: GA and postoperative peribulbar LA. The solid line shows the median, the box blot the interquartile range. The errors bars indicate 100% of the range.

Figure 2  .

Figure 2  

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Mean dose of intraoperative fentanyl infusion. Values are expressed as arithmetic mean (SD). Groups A, C, and D see Figure 1. Mean fentanyl dose was lower in group C than in group A. 

Selected References

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