SUB-CONJUNCTIVAL ANAESTHESIA IN TRABECULECTOMY AN EXPERIENCE WITH 80 CASES

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.