Trojan horse anaesthesia: A novel method of anaesthesia for pars plana vitrectomy

Topical anesthesia has been used for pars plana vitrectomy (PPV) with limited patient comfort. Thus, augmenting topical anesthesia with intracameral anesthesia (Trojan horse anesthesia) will provide pain-free experience during PPV.

This study was undertaken to evaluate the patient comfort and surgical safety using 2% lignocaine jelly augmented with intracameral 1.0% lignocaine solution for anesthetizing the eyes undergoing PPV.

This was a prospective interventional case series at tertiary care hospital.

Patients planned for PPV for indications other than retinal detachment were included in the study. The pain perception of the participants undergoing PPV under Trojan horse anesthesia was evaluated using visual analog scale (VAS).

Data analysis was done using descriptive statistics and nonparametric analysis with level of significance at P < 0.05.

There were 114 eyes of 114 patients in the study out of which 68.4% (n = 78) were males. The mean age was 42.31 years (range 14-80 years, standard deviation [SD] 18.7). The mean surgical time was 34.0 min (range 13-80 min, SD 14.2). The pain perception on VAS scale averaged 3.0 (range 0-8, SD 1.59, median 3.0). Pain scores were not affected by the age (Pearson correlation = 0.098, P = 0.3), gender (P = 0.44), or the educational status of the participant (P = 0.28). The pain scores were not affected by the indications of surgery (P = 0.58) or the use of silicone oil (P = 0.07).

Trojan horse anesthesia provides adequate analgesia for comfortable and safe 23-gauge PPV with high patient acceptability.