Vitreoretinal surgery: pre-emptive analgesia

Aim-Vitrectomies are performed either under general anesthesia (GA), local anesthesia (LA), or a combination of both. Postoperative pain is expected t o be less in patients with LA because of prolonged action of the local anae sthetic. Preemptive 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 preoperativ e LA, and 15 with postoperative LA. 30 patients received LA alone. Subjecti ve 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 postoperat ive 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.