Objective: To compare the efficacy and efficiency of retrobulbar versus sub-T enon’s capsule injection of local anesthetic in vitreoretinal surgery. Design: Prospective, randomized, double-masked clinical trial. Participants and Interve ntion: Sixty-four eyes from 61 patients undergoing vitreoretinal surgery were r andomized to receive either retrobulbar or sub-Tenon’s capsule injection of 5 ml of a 50:50 mixture of 4%lidocaine and 0.75%bupivacaine. Main Outcome Measur es: The primary outcome measured was intraoperative eye pain, whichwas rated by patients in both groups using an 11-point (0-10) numerical visual analogue sca le immediately after surgery and again the next morning. The surgeons indicated whether they perceived patient discomfort during 4 different stages of the opera tion: opening of the conjunctiva, vitrectomy (if performed), placement of sclera l buckle (if performed),and closing of the conjunctiva. The preincision time, ne ed for supplemental local anesthesia, and use of IV sedation for additional pain control were compared between the two groups. Results: Thirty-four eyeswere randomized to retrobulbar injections, and 30 ey es were randomized to sub-Tenon’s capsule injections. There was no significant difference in patient-reported intraoperative pain scores between the retrobul bar and sub-Tenon’s capsule groups when assessed immediately after surgery (me dian, 2.0 vs. 2.0; P=0.52) or the next day (median, 2.0 vs. 1.0; P=0.26). The su rgeons reported no difference between the two groups in terms of the percentages of patients with pain during opening of the conjunctiva (20.6%vs. 3.3%; P =0. 058), vitrectomy (31%vs. 32%; P=1.00), placement of scleral buckle (33.3%vs. 40%; P=1.00), and closing of the conjunctiva (26.5%vs. 26.7%; P=1.00). There was a suggestion that preincision time was longer in the sub-Tenon’s capsule g roup. Approximately equal percentages of patients in each group required supplem ental local anesthesia (38%vs. 37%; P=0.90) or IV medication (85%vs. 70%; P= 0.14) for pain control. Conclusions: Sub-Tenon’s capsule injection of local an esthetic seems as effective as retrobulbar injection at controlling intraoperati ve pain in vitreoretinal surgery.
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