Abstract
Purpose :
To describe the technique, safety profile, and outcomes of performing pars plana vitrectomy (PPV) without intravenous (IV) anesthesia. Benefits of performing PPV without IV anesthesia include increased patient satisfaction due to decreased out-of-pocket costs, no preoperative fasting requirements, and no IV-line placement prior to surgery.
Methods :
Retrospective single-surgeon case series of patients who underwent PPV without IV sedation between September 2018 and December 2021. Patients elected to undergo PPV without sedation (N=23) or with oral sedation (N=261) via 0.125 to 0.25 mg sublingual triazolam administered 30 minutes preoperatively. A 5 cc sub-tenon’s block with a 1:1 ratio of 0.75% bupivacaine and 2% lidocaine was slowly administered at the initiation of each case. A circulating nurse monitored patient vitals and electrocardiogram tracings without anesthesiologist support. Ocular and systemic adverse events, visual acuity, anatomic outcomes, supplemental block administration, and re-operation rates were examined.
Results :
A total of 284 PPVs in 255 patients (68.53 ± 11.11 years old) were performed for a variety of surgical indications including floaters, intraocular lens/cataract surgery complications, retinal detachment, and epiretinal membrane. Patients elected to undergo surgery without IV sedation due to personal preference (N=251), insurance status (N=17), anesthesia risk (N=8), difficulty fasting prior to surgery (N=4), lack of IV access (N=2), anxiety (N=1), and pregnancy (N=1). For eyes with greater than 1 month of follow up (N=223), preoperative VA of 0.62 ± 0.70 LogMAR improved to 0.25 ± 0.38 LogMAR (P<0.01) postoperatively. No intraoperative complications, systemic adverse events, need to cease surgery prematurely, or conversion to intravenous sedation occurred. 1.77% of eyes (N=5) required intraoperative supplemental sub-tenon’s block administration. Patient satisfaction was not measured; however, 96% of patients who underwent reoperation (N=4) or fellow eye surgery (N=19) requested the same method of anesthesia without IV sedation.
Conclusions :
Vitreoretinal surgery with sub-tenon’s block and oral sedation or no sedation can be safely performed without the support of an anesthesiologist. Additional trials should be performed to further quantify patient comfort and complication rates.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.