1Chief of Department of Anesthesiology, Centro de Estudos e Pesquisas Oculistas Associados (CEPOA), Rio de Janeiro, Brazil 2Department of Ophthalmology, Centro de Estudos e Pesquisas Oculistas Associados (CEPOA), Rio de Janeiro, Brazil 3Department of Lacrimal Pathway, Oculoplastics, Centro Carioca do Olho, Rio de Janeiro, Brazil
Lower complete lacrimonasal duct obstruction is a multifactorial disorder that affects tear drainage, ranging from mild symptoms like epiphora to severe cases like dacryocystitis, abscesses, fistulas, or even meningoencephalitis. It typically peaks in early childhood and in the sixth decade of life, particularly in post-menopausal women. Surgical intervention, specifically external dacryocystorhinostomy (ED) with silicone intubation, is considered the gold standard for treatment due to its long-term effectiveness and low recurrence rate. Historically mentioned in the Hammurabi Code (2250 B.C.), the technique has evolved significantly since Toti's description in 1904, incorporating antibiotics and bicanalicular silicone tube intubation. General anesthesia with endotracheal intubation remains common, but loco-regional anesthesia (LRA) is gaining interest for its benefits, including shorter hospitalization, minimal post-operative analgesia, faster recovery, and reduced bleeding. The present study compares two LRA based techniques in a new protocol, named "Double Trigeminal Territory Block". In this retrospective bi-interventional work, 512 cases were enrolled, 218 for group A, and 294, for group B, with the following data retrieved: surgery date, gender, age, initial anesthetic volume bolus (IAV), final anesthetic volume (FAV), anesthetic difference (AD), supplementary sedation required (SS) and analgesic consumption before hospital discharge (AC1), until 24h after (AC2), after 24h until 07 days (AC3) and after 07 days, until 30 days (AC4), time to hospital discharge (HD) and possible adverse events. A logistic regression model was used to calculate the propensity scores, and the summary of the regression model showed that the variables age, FAV, AC1, and HD were significantly associated with the outcome. The odds ratios (OR) for the significant variables were calculated and indicated that increased age and FAV (marked by the technique change) had a higher probability of the outcome and lower results for AC1 and HD, being the significant variables in determining the outcome in the propensity score model. The analyses indicate the importance of these variables in predicting the results for the intervention groups and that the proposed technique changes, despite increasing the initial anesthetic volume, reduced associated morbidity rates, with a drastic reduction in the number and types of anesthetic or analgesic rescue interventions during surgery, associated with an assumed increase in overall comfort level and an average reduction in hospital discharge time. The authors concluded that both “Double Trigeminal Territory Block” protocols were effective, with the one utilized in group B associated with better outcomes and, thus, recommended for practice.
Keywords: Dacryocystorhinostomy; Local-Anesthesia; Blunt Cannula; Ultrasound; Outpatient
Hugo Camara Tinoco de Siqueira., et al. “Double Trigeminal Territory Block Ultrasound-Guided with blunt cannula for Dacryocystorhinostomy in a Day-Clinic Setting: Evaluation of Two Techniques with Propensity Score Analysis”. EC Ophthalmology 16.3 (2025): 01-12.
© 2025 Hugo Camara Tinoco de Siqueira., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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