Anesthesia through a Novel Retrobulbar Catheter Provides Perioperative Pain Control for 24 h after Pars Plana Vitrectomy

Abstract

Purpose The purpose of this study was to assess the retrobulbar catheter technique for perioperative pain control in pars plana vitrectomy. Methods One hundred consecutive pars plana vitrectomies (duration 20–220 minutes) in 88 patients (age range 37–88 years) were performed by the same surgeon under retrobulbar anesthesia using a commercially available retrobulbar needle. Initially, 7 ml of mepivacaine 2% were injected, a 28-gauge flexible catheter was introduced into the retrobulbar space and the needle was withdrawn. The catheter was removed 24 h after surgery. Intra-operatively and postoperatively, the patients were asked to rate pain using a numerical scale from 0 to 10. When pain was more than grade 3, 2 ml of a local anesthetic were re-injected through the catheter. Results A first re-injection was given intraoperatively 53.0 ± 34.6 minutes after the start of surgery during 35/100 procedures, and second and third injections were needed during 12/100 and 4/100 procedures, respectively. The first postoperative re-injection was given 3.9 ± 1.5 hours after the start of surgery in 54 procedures, and second and third injections were carried out in 35/100 and 10/100 procedures respectively. Conclusions The results suggest that a temporary indwelling retrobulbar catheter allows long-lasting titratable local anesthesia during pars plana vitrectomy and titratable postoperative analgesia.