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Abstract #25953 Published in IGR 12-2
Pain relief after cyclocryodestruction for glaucoma
Surchev N; Vassileva PAutonomic and Autacoid Pharmacology 2010; 30: 51
Glaucoma is a serious ocular disease and the leading cause for irreversible blindness in patients over 65 years. When the progression of glaucomatose damage cannot be stopped with medications alone surgical intervention is needed. One possible option is cyclocryodestruction of the ciliary body - an effective procedure, which decreases aqueous production, but can be accompanied by significant postoperative pain. Aim To analyze and assess the pain therapy of patients, who underwent cyclocryodestrucion. Materials and methods The medical history of all patients who were treated by cyclocryodestrucion between April 2008 and April 2009 was reviewed. During this period, 31 patients (18 males, 13 females) with high intraocular pressure (30-54 mmHg) were treated. Standard cryocoagulation was performed under retrobulbar anesthesia. Information about the postoperative analgesics applied was gathered, as well as any patient feedback reported during the hospital stay and at follow-up visits. Results No perioperative complications were recorded. Retrobulbar anaesthesia with lidocaine and levobupivacaine was successful in most patients in blocking intraoperative pain and in four cases even ensured comfortable recuperation without significant complaints. All other patients received postoperatively intramuscular injection of tramadol. While effective, this monotherapy was not sufficient in 14 (52%) of these cases and, on patient's request, a second line of analgesics - NSAIDs - was used. Eight patients (29.5%) received complimentary metamizole and six (22%) -nimesulide. Four patients were prescribed nimesulide for several days after discharge because of continuing pain on the day after cryoapplication. Despite the use of tramadol and in about half of the cases co-medication with NSAIDs most patients reported discomfort and/or mild pain, which in single individuals persisted for several days. Discussion The nociceptive stimulation to the ciliary ganglion resulting from cryoapplication causes intense pain, which, while comparatively short-lasting, is very intense and difficult to cope. Preoperative anaesthesia plays an important role in reducing and even eliminating it (13%). Its effective alleviation often requires use of antinociceptive drugs from different groups (e.g. opioid analgesics and NSAIDs).
N. Surchev. University Eye Hospital 'Pashev', 51 Emanuil Vaskidovich St., Sofia 1517Bulgaria.
Classification:
12.10 Cyclodestruction (Part of: 12 Surgical treatment)
