Sir,

We read with interest the above analysis of local anaesthetic (LA) usage for vitreoretinal (VR) surgery in Southampton and wish to make several comments. The paper describes a 20.2% sedation rate (35.9% in ages under 35 years). A retrospective database analysis of our last 500 VR cases from mid-2003 shows 380(76%) performed under LA without an anaesthetist present, 55(11%) with an anaesthetist present, and 70(14%) under general anaesthetic. Our LA method is an 8 ml 50 : 50 mix of lignocaine 2% and bupivocaine 0.5% administered with a blunt cannula into the subtenon space. We have found this to provide excellent analgesia and akinesia without any need for sedation. This also reduces the risk of globe perforation inherent in sharp-needle intraconal injection (although this was not encountered in Southampton). Clearly we make great efficiency savings by being less reliant on anaesthetic cover, especially when providing theatre time for acute surgical VR work.

The paper goes on to state that 51.7% of the cases included in the study are ‘retinopexy +/− vitrectomy’. This could be interpreted as a significant proportion in the LA group simply receiving retinopexy for retinal tear.

Clarification on the above will be welcomed.