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M. Dombrow, G. Elkomos, N. Bhagat; Sub-Tenon Anesthesia: An Efficacious and Safe Route for Pars Plana Vitrectomies. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5985.
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To report successful use of sub-tenon anesthesia for retinal surgery - pars plana vitrectomies (PPV).
A retrospective chart review was conducted of all retinal surgeries performed by one surgeon, NB, at University Hospital, Newark, New Jersey from October 2007 through November 2007 using sub-tenon anesthesia. The type of surgery performed, route and type of anesthesia, and complications of anesthesia were recorded.
30 patients underwent retinal surgery, 20-gauge PPVs during this time period; 14 of which were performed using subtenon anesthesia with a 50/50 mixture of lidocaine 2% (without epinephrine) and marcaine 0.5%. Volume of anesthetic used ranged from 3cc to 6cc (including 3 cases that required an additional 2cc of anesthetic). All cases involved PPVs but no scleral buckles; additional procedures included membrane peel, endolaser, fluid- gas exchange, oil removal, and/or gas or oil tamponade. The time range of the surgical procedures ranged from 50 minutes to 2 hours. Surgical procedure was painless in 12 (86%) cases, akinesia was satisfactory in all 14 (100% ) cases. Minor events like inferior chemosis was noted in 4 patients.
Sub-Tenon's anesthesia has been found to be safe and effective technique for PPVs in this small study. A larger study is underway. This technique avoids the sight-threatening complication of a retrobulbar hemorrhage; it may be safer to use in patients on plavix and/or aspirin than a transcutaneous retrobulbar block.
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