Safety aspects of local anaesthesia for intraocular surgery

Purpose: The main objectives were: (i) to describe the current usage of local anaesthesia (LA) for intraocular surgery in the United Kingdom, (ii) to asses the incidence and severity of adverse events in patients who had LA, (iii) to audit the extent to which national LA safety Guidelines were being followed, (iv) to provide background information for a review of these Guidelines. Methods: A large, prospective observational study. All ophthalmology operating theatres in the National Health Service of the United Kingdom were invited to participate. During the initial week, participants were asked to complete an anonymous Report Form for every LA administered for intraocular surgery. Reporting of complications only continued for a total of three months. To validate the response rate, the theatre records of randomly-selected hospitals were inspected. Results: In the initial week, 2,827 correctly completed forms were returned. Participation rate was calculated to be 72.8% (95% Confidence Intervals: 56.4%, 96.3%). Anaesthesia techniques were: 70% LA alone, 5.8% LA with sedation, and 24.2% general anaesthesia. LA techniques were: 65.6% peribulbar, 16.9% retrobulbar, 6.7% sub-Tenon's, 4.4% subconjunctival, 2.9% topical, and 2.3% combinations. In this week, reported incidence of all adverse events within the orbit was 2.7%, and for 'systemic' adverse events it was 0.9%. In three months, an estimated 65,100 LA's were given (95% CI: 48,500, 81.700). Reported incidence of serious 'systemic' adverse events was similar for all LA techniques. 18 events were described as "life-threatening", 3 further patients had epileptic fits, and one patient's subsequent death was attributed to LA.