In Response
Year: 2018
Type: letter
Abstract: We appreciate the opportunity to respond to questions raised by Eke and Kumar1 about our recent article, which described our recommendation to use the least invasive form of anesthesia that is appropriate for the patient during cataract surgery.2 Specifically, cataract operations under topical anesthesia may have fewer complications than those performed under needle-based eye blocks, such as peribulbar and retrobulbar blocks.2 Eke and Kumar1 recommended an additional technique that we described in our article, sub-Tenon’s block, as a first choice block if topical anesthesia is not appropriate for a patient. Sub-Tenon’s blocks use a blunt cannula instead of a sharp needle to place local anesthesia behind the globe and are commonly used for cataract surgery in the United Kingdom.1 While we agree that sub-Tenon’s blocks have fewer sight-threatening complications than needle-based blocks,3 sub-Tenon’s blocks are not as commonly used by anesthesiologists in the United States. There are no data on the reasons for its slower adoption in the United States, but sub-Tenon’s blocks may be viewed as taking longer to administer and having more (inconsequential) bleeding and/or chemosis than needle-based blocks.4 While these are not reasons to avoid sub-Tenon’s blocks, they are factors that may affect US providers’ reluctance to learn to perform them. Nevertheless, we agree that sub-Tenon’s blocks may be considered in lieu of needle-based blocks, especially in cases where akinesia of the eye is preferable, and when anesthesia staff has sufficient training to perform them. Increased use of sub-Tenon’s blocks in the United States would require a commitment by institutions and faculty to learn and teach them and allowance for extra time for practitioners to perform them efficiently, especially during the initial learning curve. Karen C. Nanji, MD, MPHDepartment of AnaesthesiaHarvard Medical SchoolMassachusetts General HospitalDepartment of AnesthesiaCritical Care and Pain MedicineBoston, Massachusetts[email protected] Barbara Fain, JD, MPPBetsy Lehman Center for Patient SafetyBoston, Massachusetts Michael G. Morley, MD, ScMOphthalmic Consultants of BostonDepartment of OphthalmologyHarvard Medical SchoolBoston, Massachusetts Joseph Bayes, MDDepartment of AnesthesiaMassachusetts Eye & EarHarvard Medical SchoolBoston, Massachusetts
Source: Anesthesia & Analgesia
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G7408165595
OpenAlex ID: W4235382123