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

A B

Figure 3. Graphs illustrating the relationship between patient and surgeon satisfaction (A) and between patient pain scores and surgeon
satisfaction (B). Identical scores are represented by a single dot in each graph.

preparation after sedation, but the retrobulbar block was of 2.4, with seven patients scoring above 3. These findings
administered before sterile preparation. This approach suggest that sub-Tenon’s anesthesia is generally effective
could save preincisional time with sub-Tenon’s block, as and safe, with the potential to become a preferred method
preoperative preparation can commence immediately after for vitreoretinal surgeries in the future. Surgeons reported
sedation. Future studies should investigate the timing of high satisfaction with sub-Tenon’s anesthesia, citing
surgical protocols when using sub-Tenon’s anesthesia, its advantages in terms of patient comfort and surgical
which allows the surgeon to scrub and proceed directly to experience. In this study, patients’ pain levels were assessed
local injection and surgery. only during and immediately after surgery. The study
exclusively investigated STB without comparing it with
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Lai et al. reported that patients receiving either sub-
Tenon’s or retrobulbar anesthesia experience little or no other anesthesia methods, and postoperative pain was not
measured.
pain during and after vitreoretinal surgery; however,
patients in the sub-Tenon’s group reported lower pain A detailed study on anesthesia for 25-gauge vitrectomy
levels the day after surgery. compared retrobulbar, sub-Tenon’s, and medial canthus
episcleral anesthesia methods, focusing on intraoperative
Another study compared trans-sub-Tenon’s retrobulbar
block (TSTRB), sub-Tenon’s block (STB), and peribulbar and postoperative pain levels. Remarkably, none of the
patients, regardless of the anesthesia type used, reported
block (PBB) in vitreoretinal surgeries, evaluating analgesia,
akinesia, intraoperative pain, and postoperative pain. any postoperative pain or discomfort. This result indicates
that all three anesthesia techniques effectively managed
TSTRB, extending STB into the retrobulbar space, was pain throughout the vitrectomy, providing a pain-free
the most effective in achieving akinesia and prolonging postoperative experience for the patients involved. 33
postoperative analgesia. Notably, two patients receiving STB
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reported moderate postoperative pain, whereas patients In a study by Xu et al., patients undergoing pars plana
in the other groups reported only mild pain. No patients vitrectomy with sub-Tenon’s anesthesia reported less pain
in the TSTRB group required postoperative analgesia. than those receiving retrobulbar anesthesia during surgery
Another notable finding was that the postoperative pain and on the first postoperative day. In addition, sub-Tenon’s
score for patients receiving STB was higher than the other anesthesia was more effective in inducing akinesia and
two groups. The study concluded that TSTRB is preferable controlling eye movements compared to retrobulbar
in both sub-Tenon’s and peribulbar anesthesia. However, anesthesia. However, they did not administer supplemental
11
we did not examine the TSTRB technique in our study. IV sedation, possibly contributing to increased discomfort
in the retrobulbar group. IV sedation, often a combination
Alpay et al. evaluated sub-Tenon’s anesthesia in of opioid and/or benzodiazepine, is typically used to
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comparison to retrobulbar anesthesia, concluding that it enhance patient comfort and reduce intraoperative stress
effectively controls pain during vitreoretinal surgery and by inducing retrograde amnesia. This approach can help
could serve as an alternative to retrobulbar anesthesia. patients relax, reduce anxiety, and minimize movement
However, postoperative pain was not measured in this study. during surgery. However, it is not without risks, as it
Franco et al. assessed pain levels in patients requires an anesthesiologist monitoring of heart rate and
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administered sub-Tenon’s anesthesia during vitreoretinal blood pressure and preparation for potential complications,
surgery. Patients reported a mean postoperative pain score including apnea, airway obstruction, allergic reactions,

Volume 3 Issue 4 (2024) 5 doi: 10.36922/gtm.3900