How to manage pain following Vitrectomy for Retinal Detachment

Various postoperative pain-management strategies were found to be effective in individuals undergoing vitreoretinal surgery(vitrectomy) for retinal detachment, reports an evidence-based systematic review of randomized trials published in the Journal of VitreoRetinal Disease. These strategies include perioperative peribulbar, sub-tenon, and retrobulbar anesthetic block; perioperative systemic anti-inflammatory and postoperative systemic and topical anti-inflammatory drugs; and ice compress.

Erika Massicotte and associates performed a systematic review to examine the evidence for postoperative pain management in patients undergoing vitreoretinal surgery for retinal detachment and assessed such patients and described postoperative pain management strategies.

Nine randomized controlled studies comprising 517 patients met the inclusion criteria. Pain management included perioperative peribulbar, sub-Tenon, and retrobulbar anesthetic block; perioperative systemic anti-inflammatory and postoperative systemic and topical anti-inflammatory drugs; and ice compress.

The authors found that all studies reported better postoperative pain scores with the active treatment group except for a single study comparing retrobulbar chirocaine with and without clonidine. No serious adverse events were reported for any of the studies.

The study concluded that achievement of short-term pain relief is feasible with a variety of interventions and without narcotics. The authors warrant additional study to examine pain management strategies according to the characteristics of the anesthesia and surgery as well as the needs of the patient.

Vitrectomy is surgery to remove some or all of the vitreous humor from the eye. Anterior vitrectomy involves removing small portions of the vitreous humor from the front structures of the eye often because these are tangled in an intraocular lens or other structures.