One quadrant sub-Tenon's capsule anesthesia in anterior segment surgery

Area of Science:

• Ophthalmology
• Anesthesia

Background:

• Complications from local anesthesia in ophthalmic surgery are rising.
• Retrobulbar and peribulbar injections carry inherent risks.
• Sub-Tenon's capsule anesthesia offers a potentially safer alternative for anterior segment procedures.

Purpose of the Study:

• To compare the safety and efficacy of sub-Tenon's anesthesia with traditional retrobulbar anesthesia.
• To evaluate patient-reported pain and anesthetic effectiveness.
• To assess the rate of akinesia achieved with each technique.

Main Methods:

• A randomized study comparing 1-quadrant sub-Tenon's anesthesia (1-QST) with retrobulbar anesthesia.
• 300 patients received 1-QST, and 270 received retrobulbar anesthesia.
• Anesthetic agents included lidocaine and bupivacaine; pain was assessed using a numerical rating scale.

Main Results:

• Pre- and postinjection intraocular pressures were similar between groups.
• Sub-Tenon's anesthesia resulted in lower median pain scores during anesthetic delivery (1 vs. 2) and surgery (1 vs. 2).
• Complete akinesia was achieved in 41% of 1-QST patients versus 69% of retrobulbar patients, with incomplete akinesia rarely impacting surgery.

Conclusions:

• Sub-Tenon's anesthesia is a simple, safe, and effective alternative to retrobulbar anesthesia for anterior segment surgery.
• It offers comparable intraocular pressure control with reduced patient discomfort.
• While achieving lower rates of complete akinesia, its functional impact on surgery is minimal.