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Objective: To determine the patients tolerability, comfort, ease of application and surgeons convenience
with sub-conjunctival anaesthesia for trabeculectomy in our clinical setup.
Material and Methods: It was a prospective and observational study conducted at the department of
Ophthalmology, Postgraduate Medical Institute, Hayatabad Medical Complex and Khyber Teaching
Hospital, Peshawar. All patients were injected with up to 1 ml of a 1:1mixture of 2% lignocain with
epinephrine and 0.75% bupivacaine sub-conjunctivally and operated for trabeculectomy. Intra-operative
pain, presence of eye movements and complications of anaesthesia were monitored. Bleb leak and ptosis
were assessed postoperatively. Patient discomfort was assessed intraoperatively and 24 hours
postoperatively using a standardized verbal descriptive chart with 0 to 4 pain scoring levels.
Results: Eighty patients underwent sub-conjunctival anaesthesia for trabeculectomy. Sixty-eight (85%)
patients remained comfortable throughout the procedure. Only 3 (3.75%) patients required supplemental
subconjunctival anaesthesia block during surgery, while 7 (8.75%) patients required a facial block. Two
(2.5%) patients needed retrobulbar block. No surgery was postponed and none of the patient required
general anesthesia. Most common complication noted was chemosis of the conjunctiva (70%). In two cases
(2.5%) it interfered with the surgery and the surgery time was prolonged. Small sub-conjunctival
hemorrhage developed in 43 (53.75%) patients; however, this did not interfere with the surgery. No case of
postoperative bleb leak and ptosis was noted.
Conclusion: The technique of subconjunctival anaesthesia is safe, effective, tolerable, and convenient. It
is not associated with any remarkable postoperative complications because it is performed under direct
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