Anesthesia in retinal surgery: A national survey

Local-regional anesthesia (LRA) techniques used for vitreoretinal surgery include peribulbar (PBA) and sub-Tenon's anesthesia (STA). Despite their increasing use over general anesthesia, there are no clear recommendations on their indications and contraindications. Furthermore, French practices in this field have not been evaluated. The objectives of this survey were to describe current French anesthesia practices for vitreoretinal surgery and to identify professionals' needs.

A 23-question questionnaire was sent to French-speaking retinal surgeons via the Club Francophone des Spécialistes de la Rétine (CFSR). Questions focused on the type of anesthesia used according to the surgical indication, the LRA methods used, and surgeons' needs.

The questionnaire was completed by 114 surgeons. PBA and general anesthesia were most frequently used for vitrectomy and scleral buckling, respectively. Private-sector surgeons and surgeons with>10 years of experience used PBA more frequently than public-sector surgeons and surgeons with<5 years of experience. When LRA was used, PBA was clearly preferred to STA. The techniques used and the contraindications to PBA were very heterogeneous. Hypnosis was hardly ever used, even as a complement to another modality. Most surgeons needed guidelines, and a study comparing PBA and STA seemed necessary.

This French survey revealed a wide range of practices. The latest data on anesthesia techniques and contraindications in the literature are presented. Further studies are needed, in particular studies comparing PBA and STA, assessing if severe myopia could be a contraindication to PBA, studies on the relevance of ultrasound guidance, and studies on hypnosis and its possible benefits during vitreoretinal surgery.