DefinePK

Research Objective

To compare the surgeon's ease level and duration of surgery in topical anesthesia with peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months.

Methodology

A randomized controlled trial was conducted with 110 patients, equally divided into two groups: Group A (topical anesthesia, n=55) and Group B (peribulbar anesthesia, n=55). Topical anesthesia involved instilling 0.5% proparacaine hydrochloride eye drops. Peribulbar anesthesia involved a 5cc injection of 0.5% bupivacaine and 1% lidocaine. Surgical time was recorded from the first incision to the last suture, and surgeon's ease was assessed on a 4-grade scale. Data was analyzed using SPSS version 25.0 with independent t-tests for continuous variables.

Methodology Flowchart

                        graph TD;
    A["Patient Recruitment & Inclusion Criteria"] --> B["Randomization"];
    B --> C["Group A: Topical Anesthesia"];
    B --> D["Group B: Peribulbar Anesthesia"];
    C --> E["Vitrectomy Surgery"];
    D --> E;
    E --> F["Record Surgical Time"];
    E --> G["Record Surgeon's Ease"];
    F --> H["Data Analysis SPSS"];
    G --> H;
    H --> I["Compare Outcomes"];
    I --> J["Conclusion"];                    

Discussion

Topical anesthesia is presented as a safer and more convenient alternative to peribulbar anesthesia for vitrectomy, offering advantages such as avoiding needle-related complications and potentially quicker recovery. While topical anesthesia may sometimes require supplemental pain management, in this study, it demonstrated superior outcomes in terms of surgeon's ease and surgical duration without the need for additional sedation. The study highlights the efficacy of 23-G pars plana vitrectomy under topical anesthesia for selected patients.

Key Findings

The mean age of patients was 43.83±9.76 years, with 70.9% males. The mean duration of surgery was 30.32±7.07 minutes, and the surgeon's ease score was 2.30±0.98. Topical anesthesia resulted in a significantly shorter mean duration of surgery (28.12±6.57 minutes) and a higher surgeon's ease score (3.11±0.90) compared to peribulbar anesthesia (32.52±6.92 minutes and 2.67±0.90, respectively), with P<0.05 for both.

Conclusion

Topical anesthesia without sedation is superior to peribulbar anesthesia for 23-G pars plana vitrectomy in patients with unresolving vitreous hemorrhage, specifically regarding surgeon's ease level and duration of surgery.

Fact Check

1. Sample Size: The study included a total of 110 patients, equally divided into two groups of 55 each.
2. Anesthetic Agents: Group A used 0.5% proparacaine hydrochloride eye drops, while Group B received a 5cc injection containing 2.5ml of 0.5% bupivacaine and 2.5ml of 1% lidocaine.
3. Statistical Significance: A P-value <0.05 was considered significant, and significant differences were found for both mean duration of surgery (P<0.001) and surgeon's ease level (P=0.012).

Mind Map