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Global Translational Medicine Retrobulbar and sub-Tenon’s local anesthesia

(SD) and a range of 39 – 98 years. The mean participant associated with lower surgeon satisfaction. A moderate–
weight was 70.3 ± 14.8 kg (range, 47 – 120 kg). Eleven high positive correlation was observed between patient and
patients received retrobulbar anesthesia, and the remaining surgeon satisfaction (B: 0.686; P < 0.001), suggesting that
42 patients received sub-Tenon’s capsule anesthesia. higher patient satisfaction was linked to greater surgeon
No patient required additional sedation beyond initial satisfaction (Figure 3). These findings underscore the
administration. Six patients in the sub-Tenon’s group and interconnected nature of patient and surgeon satisfaction
none in the retrobulbar group reported postoperative and highlight the influence of patient pain levels on overall
nausea and/or vomiting. In our study, one surgery was satisfaction with the surgical experience.
excluded due to retrobulbar hemorrhage (Figure 2). No 4. Discussion
statistically significant differences were observed between
the two groups regarding demographic factors such as Our study found no significant differences in pain scores,
age, sex, and weight. Similarly, no statistically significant patient satisfaction, and surgeon satisfaction between
differences in reported pain scores, patient or surgeon retrobulbar and sub-Tenon’s anesthesia, each supplemented
satisfaction, or patient discomfort during surgery, in the by intravenous (IV) sedation for vitreoretinal surgery.
recovery room, or 24 h postsurgery were found between These results suggest that both anesthetic methods provide
the groups (P > 0.05; Table 1). comparable outcomes for managing intraoperative

A negative correlation was found between patient pain discomfort and achieving satisfactory surgical results.
scores and surgeon satisfaction in both groups (B: −0.465; Previous studies have reported a higher complication
P < 0.001), indicating that increased patient pain was rate, such as retrobulbar hemorrhage, with retrobulbar
techniques, but we observed no such difference. However,
this may be attributed to the small sample size in our
retrobulbar group as well as the lack of data on underlying
systemic conditions. Patients scheduled for pars plana
vitrectomy often present with systemic conditions requiring
anticoagulants, such as hypertension, cardiovascular
disorders, and diabetes. Given the higher likelihood of
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retrobulbar hemorrhage in patients on anticoagulants and
a low tendency to discontinue this medication by primary
doctors, an anesthetic technique with a lower risk of
complications is preferable in these cases. 30
Figure 2. A patient presenting with retrobulbar hemorrhage following
retrobulbar anesthesia injection, resulting in rescheduled surgery. Given these considerations, evaluating the choice
Emergent canthotomy and cantholysis were performed immediately. The of anesthetic technique within the context of a patient’s
image shows notable chemosis, total ptosis due to periorbital edema, and overall health is crucial. In settings where systemic
ecchymosis of the eyelids. conditions and the use of anticoagulant medications are
common, selecting an anesthetic method with a lower risk
Table 1. Comparison of patient pain score, patient of complications is essential.
satisfaction, and surgeon satisfaction among groups
Two studies assessed the efficacy of sub-Tenon’s and
Sub-Tenon’s Retrobulbar P-value retrobulbar anesthesia in vitreoretinal surgery, finding both
anesthesia (n=42) anesthesia techniques to be comparably effective. 23,27 Reichstein et al.
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(n=11)
noted that a history of scleral buckle placement influenced
Pain during surgery 2.74 ± 2.57 3 ± 3.16 0.964 the preference for retrobulbar over sub-Tenon’s anesthesia.
Pain at recovery 1.46 ± 1.92 1.91 ± 2.07 0.511 Their study concluded that sub-Tenon’s anesthesia is as
Pain 24 h after surgery 0.52 ± 1.25 1.09 ± 1.58 0.111 effective and safe as retrobulbar anesthesia for vitreoretinal
Patient satisfaction 9.74 ± 0.91 9.82 ± 0.60 0.948 surgeries and could potentially replace retrobulbar
Surgeon satisfaction anesthesia. No complications, such as conjunctival
Weak 0 0 0.814 chemosis, retrobulbar hemorrhage, or globe perforation,
23,27
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Good 3 (7.1) 1 (9.1) were observed in either group. In these studies,
anesthesia was administered following IV sedation and
Very good 7 (16.7) 1 (9.1) before preoperative sterile preparation. However, in our
Excellent 32 (76.2) 8 (81.9) study, we administered sub-Tenon’s block after sterile

Volume 3 Issue 4 (2024) 4 doi: 10.36922/gtm.3900