Endoscopic Endonasal Dacryocystorhinostomy under Local Anesthesia or Assisted Local Anesthesia

Area of Science:

• Ophthalmology
• Otorhinolaryngology
• Surgical Procedures

Background:

• Endoscopic endonasal dacryocystorhinostomy (EENDCR) is an effective, safe, and scar-free treatment for epiphora.
• Traditional EENDCR requires general anesthesia, limiting its accessibility where such facilities are scarce.
• Local anesthesia (LA) or assisted local anesthesia (ALA) presents a potential alternative for EENDCR.

Purpose of the Study:

• To evaluate the pain tolerability of patients undergoing EENDCR under LA or ALA.
• To assess the feasibility of EENDCR in settings with limited general anesthesia availability.
• To address the lack of similar studies in Nepal regarding EENDCR under local anesthesia.

Main Methods:

• A prospective, nonrandomized, interventional study involving 100 patients undergoing EENDCR with stenting.
• Patients were treated under LA or ALA at a tertiary eye care center from January 2018 to April 2019.
• Pain was assessed using the Verbal Rating Scale (VRS) during surgical steps, with a follow-up of 6 to 24 months.

Main Results:

• Ninety-two eyes were operated under LA, and 14 eyes (11 patients) received ALA.
• Patients reported minimal to moderate pain during specific steps under LA (VRS 3-6), while ALA patients reported no pain (VRS 0-2).
• The overall success rate for EENDCR was 96.2%, with surgery durations ranging from 15 to 45 minutes.

Conclusions:

• EENDCR can be successfully performed under LA or ALA.
• The choice between LA and ALA should be based on patient indication and preference.
• This approach expands the accessibility of EENDCR for epiphora treatment.