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Anaesthesia in vitreo-retinal surgery

Absalom, A.*; Mitchell, E.*; Goldsmith, C.*; Burton, R.*

European Journal of Anaesthesiology: April 2005 - Volume 22 - Issue 4 - p 316–317
doi: 10.1017/S0265021505230533

*Departments of Anaesthesia and Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK

Correspondence to: Anthony Absalom, Department of Anaesthesia, Box 93, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, UK. E-mail:; Tel: +44 1223 217434; Fax: +44 1223 217223

Accepted for publication October 2004


The paper by Farmery and colleagues [1] has eloquently demonstrated the benefits that accrue from performing a sub-Tenon block in patients who are undergoing general anaesthesia for vitreo-retinal procedures. Their study did not address the question of whether general anaesthesia itself is necessary.

Sub-Tenon blocks are known to provide effective anaesthesia of the orbit and contents for several hours [2-5]. Although many surgeons prefer general anaesthesia for vitreo-retinal procedures, this is by no means universal. A recent audit showed that more than 250 vitreo-retinal procedures were performed during the course of a year at our hospital. Of these, 22% were performed under general anaesthesia. In the remaining patients the procedures were performed under sub-Tenon block. None of the latter patients required intraoperative sedation or systemic analgesia. Most operations were completed within, or soon after, an hour and there did not appear to be any difference in surgical outcome when compared with those patients undergoing general anaesthesia and a local block.

We believe that a randomized, controlled trial is now required to definitively determine whether or not general anaesthesia is required in addition to a sub-Tenon block for vitreo-retinal procedures that can be performed within an hour.

A. Absalom

E. Mitchell

C. Goldsmith

R. Burton

*Departments of Anaesthesia and Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK

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1. Farmery AD, Shlugman D, Rhaman R, Rosen P. Sub-Tenon's block reduces both intraoperative and postoperative analgesia requirements in vitreo-retinal surgery under general anaesthesia. Eur J Anaesthiol 2003; 20: 973-978.
2. Canavan KS, Dark A, Garrioch MA. Sub-Tenon's administration of local anaesthetic: a review of the technique. Br J Anaesthiol 2003; 90: 787-793.
3. Guise PA. Sub-Tenon anesthesia: a prospective study of 6,000 blocks. Anesthesiology 2003; 98: 964-968.
4. Calenda E, Olle P, Muraine M, Brasseur G. Peribulbar anesthesia and sub-Tenon injection for vitreoretinal surgery: 300 cases. Acta Ophthalmol Scand 2000; 78: 196-199.
5. Sharma T, Gopal L, Parikh S, Shanmugam MP, Badrinath SS, Mukesh BN. Parabulbar anesthesia for primary vitreoretinal surgery. Ophthalmology 1997; 104: 425-428.
© 2005 European Society of Anaesthesiology