Peribulbar block vs. general anaesthesia for corneal transplantation: analgesic requirements and pain control

Background and Goal of Study: 

Effective anaesthesia for corneal transplantation (CT) can be achieved with general (GA) or regional anaesthesia (RA). Evidence regarding the comparative merits of each technique is scarce. CT has usually been performed under GA, due to fear of the ‘open-sky’ situation. Peribulbar block (PBB) is an increasingly used technique for CT. We believe that PBB can achieve effective surgical anaesthesia and postoperative analgesia with lower analgesic requirements and similar surgical conditions, compared to GA. The aim of this study was to compare the analgesic efficacy of PBB and GA for CT.

Materials and Methods:

We conducted a prospective observational study to compare CT surgery in adults under BPB and GA. After local ethics committee approval, CT performed between August and November 2017 were studied. Exclusion criteria included refusal to participate. Data collected on each patient included age, gender, American Society of Anesthesiologists physical status (ASA), procedure and anaesthesia lengths, analgesic drug administration, pain on arrival in the operating theatre and 30 minutes after surgery, postoperative analgesic needs and the opinion of the ophthalmologist regarding surgical conditions. Data was analysed using Statistical Package for the Social Sciences version 22. The statistical tests used were Chi-squared and Mann-Whitney U. Statistical significance was assumed for p < 0.05.

Results and Discussion: 

The study included a total of 39 patients. PBB was used for 20 CTs, 16 of which were lamelar keratoplasty. GA was used for 19 CTs, 15 of which were PK. Age, gender and ASA status in the two populations were similar, although there was a trend (p = 0.057) towards GA use in younger patients. Total fentanyl dose (p  < 0.001), paracetamol (p  < 0.05) use, tramadol use (p  < 0.05)  and non-steroidal anti-inflammatory use (p  < 0.05)  were significantly lower in the PBB group. There were no differences in pain score on arrival, although there was a trend towards lower pain scores 30 minutes after surgery in the PBB group (p = 0.077). No difference was observed regarding the surgeon’s opinion of surgical conditions.


Conclusion: 

In this study, CT under PBB provided comparable pain control and surgical conditions to GA, with much lower systemic analgesic requirements. Further evidence from randomised trials is required to minimise potential confounders in prospective trials such as this.

08 / Peribulbar block vs. general anaesthesia for corneal transplantation: analgesic requirements and pain control