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Impressum
Retrobulbar Catheter Technique for Postoperative Titratable Analgesia in Cyclodestructive and Retinal Destructive Procedures in Neovascular Glaucoma
1Jäger M., 2Hemmerling T., 1Jonas J. B.
1Augenklinik, Fakultät für klinische Medizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim 2Department of Anesthesiology, Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montréal, Canada
Purpose: To assess an indwelling retrobulbar catheter for delivery
of intraoperative anesthesia and postoperative analgesia in patients undergoing
painful cyclodestructive and retinal destructive procedures as treatment
of neovascular glaucoma.
Patients and Methods: The prospective clinical interventional study
included all 11 patients undergoing cyclocryocoagulation and / or retinal
exocryocoagulation as treatment of neovascular glaucoma due to proliferate
ischemic retinopathies. Using a commercially available retrobulbar needle
with a diameter of 0.80 mm and a length of 38 mm, 7 ml of a mepivacaine
2% were injected. Through the same needle, a 28-gauge commercially available
flexible catheter was introduced into the retrobulbar space, the needle
was withdrawn, and the catheter was fixed in place. When the patients
started to feel pain during or after surgery, 2 ml of a local anesthetic
were re-injected through the catheter. The catheter was removed 24 after
surgery.
Results: Due to increasing pain in the postoperative period, 8
(72.7%) patients received a re-injection 156.3 ± 94.6 minutes after
the preoperative injection. Seven (63.6%) patients demanded a second re-injection
268.6 ± 45.7 minutes after the preoperative injection, and three
(27.3%) patients asked for a third postoperative injection 333.3 ±
79.1 minutes after the preoperative injection. Re-injection of the local
anesthetic through the catheter markedly decreased the pain within 5 min
of injection in all patients. Removal of the catheter after surgery was
unremarkable. No infections were observed. Diplopia or other motility
problems were not detected. Introducing and fixation of the catheter took
less than 5 minutes in all patients. No cardiopulmonary and central nervous
side effects were noticed.
Conclusions: Avoiding side-effects of systemic analgesics and sedatives,
an indwelling retrobulbar catheter for repeatable postoperative injections
of local anesthetics is useful and effective for titratable postoperative
analgesia after painful cyclodestructive or retinal destructive surgery
as treatment of neovascular glaucoma.