Local versus general anaesthesia for adults undergoing vitrectomy surgery

Review question

We reviewed the evidence about the effect of general anaesthesia compared to different types of local anaesthesia in vitreo-retinal surgery (surgery involving the inner substance of the eye and the retina (the light-sensitive layer of tissue at the back of the eyeball)).

We did not find any eligible studies for our review.

Background

Vitrectomy refers to the removal of the jellylike substance inside the eye. It is an approach used to treat disease of the retina including diabetic retinopathy as well as retinal detachment. Retinal detachment is a process where the retina peels off the back of the eye. With the ageing global population as well as an increased frequency of diabetes, vitrectomy is becoming a more commonly performed procedure. Traditionally, this procedure has been performed with general anaesthesia. General anaesthesia is a drug (given as a gas or inhaled) to bring about a reversible loss of consciousness. Local anaesthesia involves the administration of local anaesthetic to the desired area to cause a loss of sensation in a specific part of the body. There is a perception in the medical community that local anaesthesia may be slightly safer than general anaesthesia. There have so far been no good-quality reviews addressing this issue.

Study characteristics

We searched the databases until July 2016 but found no suitable studies.

Key results

This review did not find any relevant clinical evidence in the form of prospective randomized trials to determine which type of anaesthesia may be better for adults undergoing this procedure. It is important to conduct well-designed studies in the future which could help us to decide the answer to this question.

Quality of evidence

We did not analyse the quality of evidence as we did not find any suitable studies to include in our review.

Authors' conclusions: 

This systematic review failed to locate relevant clinical evidence to support or refute a pars plana vitrectomy performed with various modalities of local anaesthesia versus general anaesthesia. Good-quality clinical trials are needed to define the role of local versus general anaesthesia for pars plana vitrectomy.

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Background: 

Vitrectomy surgery is one of the commonest ophthalmic procedures performed across the world. It may be performed using general or local anaesthesia encompassing regional or topical anaesthesia depending on a number of factors, including patient suitability, and patient, surgeon or anaesthetist preference. There have so far been no evidence-based recommendations on the best form of anaesthesia for this intervention. There is no clear collated evidence base as to the best type of anaesthesia to reduce harm, and provide best surgical conditions and optimal outcome for patients.

Objectives: 

To compare local with general anaesthesia for adults undergoing pars plana vitrectomy.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library and the reference lists of updated studies on the 25th of July 2016; MEDLINE via Ovid SP (1972 to July 2016) and Embase via Ovid SP (1972 to July 2016). In addition we searched the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) in July 2016. We searched the proceedings of the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) up to July 2016 for information about other relevant studies.

We also searched appropriate databases for ongoing reviews. We did not apply any language restriction. We assessed the search as up-to-date on the 25th of July 2016.

Selection criteria: 

We planned to include all published randomized controlled trials (RCTs) involving comparison of different modalities of local anaesthesia with general anaesthesia for pars plana vitrectomy. We considered the following different modalities of local anaesthesia: sub-Tenon's anaesthesia, retrobulbar anaesthesia, topical anaesthesia, peribulbar anaesthesia. We planned to include cluster-randomized controlled trials. We excluded quasi-RCT trials.

Data collection and analysis: 

Two review authors conducted independent searches and assessed identified studies for inclusion according to the prespecified selection criteria. Two review authors assessed trial quality and planned to extract the data.

Main results: 

We found no eligible studies that met our inclusion criteria and were therefore unable to perform a meta-analysis or conduct a methodological quality assessment.

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