[Topical versus peribulbar anesthesia in nonpenetrating deep sclerectomy]

Area of Science:

• Ophthalmology
• Anesthesiology
• Surgical Innovation

Context:

• Ophthalmic surgery has advanced significantly, with topical anesthesia becoming standard for cataract procedures due to improved patient recovery.
• Previous studies suggest topical anesthesia can be effective for trabeculectomy, indicating its potential for other glaucoma surgeries.
• Nonpenetrating deep sclerectomy is a surgical option for glaucoma management, necessitating effective anesthesia for patient comfort and surgical success.

Purpose:

• To compare patient pain and comfort levels following nonpenetrating deep sclerectomy under two different anesthesia techniques: topical anesthesia with sedation versus peribulbar anesthesia.
• To evaluate pain perception at two time points: 15 minutes and 24 hours after the surgical procedure.

Summary:

• A randomized prospective study involving 69 patients undergoing nonpenetrating deep sclerectomy compared topical anesthesia (proximetacaine 0.5% with propofol sedation) to peribulbar anesthesia (lidocaine 2% with bupivacaine 0.75%).
• Patients receiving topical anesthesia reported significantly less pain 15 minutes post-surgery (mean VAS 0.11 vs. 0.82, p=0.014).
• No significant difference in pain was observed between the groups at the 24-hour follow-up (mean VAS 2.83 vs. 2.45, p=0.125).

Impact:

• Topical anesthesia combined with propofol sedation provides a valuable and effective alternative for nonpenetrating deep sclerectomy, potentially enhancing immediate postoperative patient experience.
• This approach may offer comparable or improved comfort levels to traditional peribulbar anesthesia, supporting its wider adoption in ophthalmic procedures.
• The findings contribute to optimizing anesthetic protocols in glaucoma surgery, focusing on patient-centered outcomes like pain management and comfort.