• Edward J K Lee, Mona Khandwala, and Carole A Jones.
• The Eye Ear and Mouth Unit, Maidstone Hospital, Barming, Kent ME169QQ, UK.
• Orbit. 2009 Jan 1; 28 (6): 388-91.

BackgroundPtosis surgery is performed under local anaesthetic to allow intra-operative assessment of lid positioning. Most commonly the anaesthetic is administered as a subcutaneous infiltration at the surgical site. Ptosis surgery using a regional nerve block has also been described, with reported advantages for minimising levator paralysis and disruption of the surgical landmarks. This study was designed to compare patient satisfaction with the two techniques of local anaesthetic administration.Methods32 patients undergoing ptosis surgery were enrolled into a randomised controlled trial to receive local anaesthetic either by subcutaneous infiltration or by regional nerve block. Patient satisfaction was measured postoperatively with a self-administered vertical response column questionnaire, the Iowa Satisfaction with Anaesthesia Scale (ISAS).ResultsOf the 32 patients who were recruited 3 patients were excluded from analysis due to incomplete questionnaires or deviation from the trial protocol. Patient groups were well matched in terms of age, sex, time on waiting list, anaesthetic risk score, and operating grade of surgeon. Comparison of ISAS scores with the Mann Whitney test demonstrated an equal level of patient satisfaction with the two techniques.ConclusionThis randomised controlled trial found regional nerve blocks to be associated with equal levels of patient satisfaction as the more standard technique of diffuse infiltration of local anaesthetic along the upper eyelid. This result supports the use of regional nerve blocks as a valid alternative for anaesthesia in ptosis surgery.

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