Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report
Background/Objectives: Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinocic...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-10-01
|
| Series: | Biomedicines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9059/12/10/2303 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850205089445183488 |
|---|---|
| author | Michał Jan Stasiowski Anita Lyssek-Boroń Katarzyna Krysik Dominika Majer Nikola Zmarzły Beniamin Oskar Grabarek |
| author_facet | Michał Jan Stasiowski Anita Lyssek-Boroń Katarzyna Krysik Dominika Majer Nikola Zmarzły Beniamin Oskar Grabarek |
| author_sort | Michał Jan Stasiowski |
| collection | DOAJ |
| description | Background/Objectives: Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. Methods: A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. Results: A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (<i>p</i> = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (<i>p</i> = 0.002; <i>p</i> < 0.05) with no influence on the dose of IROA (<i>p</i> = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. Conclusions: PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects. |
| format | Article |
| id | doaj-art-fd32b9cf2a7747b78d4764020d2a734e |
| institution | OA Journals |
| issn | 2227-9059 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj-art-fd32b9cf2a7747b78d4764020d2a734e2025-08-20T02:11:09ZengMDPI AGBiomedicines2227-90592024-10-011210230310.3390/biomedicines12102303Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary ReportMichał Jan Stasiowski0Anita Lyssek-Boroń1Katarzyna Krysik2Dominika Majer3Nikola Zmarzły4Beniamin Oskar Grabarek5Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, PolandDepartment of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, PolandDepartment of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, PolandDepartment of Anaesthesiology and Intensive Care, St Barbara’s 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, PolandCollegium Medicum, WSB University, 41-300 Dabrowa Gornicza, PolandCollegium Medicum, WSB University, 41-300 Dabrowa Gornicza, PolandBackground/Objectives: Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. Methods: A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. Results: A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (<i>p</i> = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (<i>p</i> = 0.002; <i>p</i> < 0.05) with no influence on the dose of IROA (<i>p</i> = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. Conclusions: PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects.https://www.mdpi.com/2227-9059/12/10/2303adequacy of anesthesiabupivacaineintolerable postoperative pain perceptionperibulbar blockropivacainesurgical pleth index |
| spellingShingle | Michał Jan Stasiowski Anita Lyssek-Boroń Katarzyna Krysik Dominika Majer Nikola Zmarzły Beniamin Oskar Grabarek Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report Biomedicines adequacy of anesthesia bupivacaine intolerable postoperative pain perception peribulbar block ropivacaine surgical pleth index |
| title | Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report |
| title_full | Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report |
| title_fullStr | Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report |
| title_full_unstemmed | Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report |
| title_short | Evaluating the Efficacy of Pre-Emptive Peribulbar Blocks with Different Local Anesthetics or Paracetamol Using the Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries: A Preliminary Report |
| title_sort | evaluating the efficacy of pre emptive peribulbar blocks with different local anesthetics or paracetamol using the adequacy of anesthesia guidance for vitreoretinal surgeries a preliminary report |
| topic | adequacy of anesthesia bupivacaine intolerable postoperative pain perception peribulbar block ropivacaine surgical pleth index |
| url | https://www.mdpi.com/2227-9059/12/10/2303 |
| work_keys_str_mv | AT michałjanstasiowski evaluatingtheefficacyofpreemptiveperibulbarblockswithdifferentlocalanestheticsorparacetamolusingtheadequacyofanesthesiaguidanceforvitreoretinalsurgeriesapreliminaryreport AT anitalyssekboron evaluatingtheefficacyofpreemptiveperibulbarblockswithdifferentlocalanestheticsorparacetamolusingtheadequacyofanesthesiaguidanceforvitreoretinalsurgeriesapreliminaryreport AT katarzynakrysik evaluatingtheefficacyofpreemptiveperibulbarblockswithdifferentlocalanestheticsorparacetamolusingtheadequacyofanesthesiaguidanceforvitreoretinalsurgeriesapreliminaryreport AT dominikamajer evaluatingtheefficacyofpreemptiveperibulbarblockswithdifferentlocalanestheticsorparacetamolusingtheadequacyofanesthesiaguidanceforvitreoretinalsurgeriesapreliminaryreport AT nikolazmarzły evaluatingtheefficacyofpreemptiveperibulbarblockswithdifferentlocalanestheticsorparacetamolusingtheadequacyofanesthesiaguidanceforvitreoretinalsurgeriesapreliminaryreport AT beniaminoskargrabarek evaluatingtheefficacyofpreemptiveperibulbarblockswithdifferentlocalanestheticsorparacetamolusingtheadequacyofanesthesiaguidanceforvitreoretinalsurgeriesapreliminaryreport |