REGIONAL OCULAR BLOCKS VERSUS SYSTEMIC SEDATION IN OPHTHALMOLOGY: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv16n53-135Keywords:
Ophthalmic Surgery, Regional Anesthesia, Conscious Sedation, Ocular BlocksAbstract
Introduction: Regional ocular anesthesia is widely employed in ophthalmic surgery to provide analgesia, akinesia, and patient comfort, while minimizing systemic complications. The balance between safety, efficacy, and patient satisfaction has led to debate regarding whether regional ocular blocks or systemic sedation should be preferred in various ophthalmic procedures.
Objective: The main objective of this review was to compare the efficacy, safety, and patient outcomes of regional ocular blocks versus systemic sedation in ophthalmology. Secondary objectives included assessing pain control, intraoperative hemodynamic stability, surgeon satisfaction, and perioperative complications associated with each technique.
Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP databases for studies published in the last five years, extending to ten years if fewer than ten eligible studies were found. Inclusion criteria comprised randomized controlled trials, prospective observational studies, and meta-analyses comparing regional ocular blocks (retrobulbar, peribulbar, sub-Tenon’s, or topical) with systemic sedation during ophthalmic surgeries. Exclusion criteria were animal studies, pediatric populations, and articles not reporting intraoperative or postoperative outcomes. Data were synthesized narratively and analyzed by GRADE methodology for evidence certainty.
Results and Discussion: A total of 1,156 records were screened, and 18 studies met inclusion criteria. Regional blocks generally provided superior intraoperative analgesia and ocular immobility, while systemic sedation was associated with higher patient satisfaction in short, low-pain procedures. Combined approaches (sub-Tenon’s block with mild sedation) showed optimal balance between safety and comfort. Complication rates were lower with sub-Tenon’s blocks compared to retrobulbar anesthesia.
Conclusion: Both regional ocular blocks and systemic sedation remain valuable anesthetic strategies in ophthalmic surgery. The choice should be guided by surgical complexity, patient comorbidities, and desired recovery profile. Integration of minimally invasive regional techniques with light sedation offers a tailored, evidence-based approach to optimize outcomes and safety.
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