SUB-CONJUNCTIVAL ANAESTHESIA IN TRABECULECTOMY AN EXPERIENCE WITH 80 CASES

Abstract

Objective: To determine the patients tolerability, comfort, ease of application and surgeons convenience

with sub-conjunctival anaesthesia for trabeculectomy in our clinical setup.

Material and Methods: It was a prospective and observational study conducted at the department of

Ophthalmology, Postgraduate Medical Institute, Hayatabad Medical Complex and Khyber Teaching

Hospital, Peshawar. All patients were injected with up to 1 ml of a 1:1mixture of 2% lignocain with

epinephrine and 0.75% bupivacaine sub-conjunctivally and operated for trabeculectomy. Intra-operative

pain, presence of eye movements and complications of anaesthesia were monitored. Bleb leak and ptosis

were assessed postoperatively. Patient discomfort was assessed intraoperatively and 24 hours

postoperatively using a standardized verbal descriptive chart with 0 to 4 pain scoring levels.

Results: Eighty patients underwent sub-conjunctival anaesthesia for trabeculectomy. Sixty-eight (85%)

patients remained comfortable throughout the procedure. Only 3 (3.75%) patients required supplemental

subconjunctival anaesthesia block during surgery, while 7 (8.75%) patients required a facial block. Two

(2.5%) patients needed retrobulbar block. No surgery was postponed and none of the patient required

general anesthesia. Most common complication noted was chemosis of the conjunctiva (70%). In two cases

(2.5%) it interfered with the surgery and the surgery time was prolonged. Small sub-conjunctival

hemorrhage developed in 43 (53.75%) patients; however, this did not interfere with the surgery. No case of

postoperative bleb leak and ptosis was noted.

Conclusion: The technique of subconjunctival anaesthesia is safe, effective, tolerable, and convenient. It

is not associated with any remarkable postoperative complications because it is performed under direct

visualization.