Patients' Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy.

Purpose: The purpose of this study was to evaluate the correlation between pain associated with retrobulbar block and anxiety levels before the injection.

Methods: This prospective observational, noninterventional study included consecutive patients who received a retrobulbar block by a single surgeon prior to undergoing 25G PPV at the Department of Ophthalmology, Rambam Health Care Campus, between April 2016 and August 2017. Patients plotted their anxiety levels (scale 0-10) using the visual analogue scale for anxiety (VASA), and immediately after receiving the injection, they plotted their experienced level of pain (scale 0-10) using the visual analogue scale for pain (VAS), with scores ≥7 defined as severe.

Results: Overall, 48 eyes of 48 patients aged 68.4 ± 10.3 years were included, of which 62.5% were of male gender. Severe anxiety and pain were experienced by 10.4% and 12.5%, respectively. There was a significant correlation between VASA and VAS scores ( = 0.43, =0.002) with no other preprocedural parameters demonstrating a significant association with the VAS score. In multivariate analysis, the VASA score was the only factor that was significant (=0.01), and a patient with a severe VASA score was 20 times more likely of experiencing severe pain (=0.006). The ROC curve analysis revealed an area under the curve of 0.89 ( < 0.001), and a VASA score >4 demonstrated a sensitivity of 83.3% and a specificity of 73.8% in predicting severe pain.

Conclusions: Approximately 10% of patients experience severe anxiety and pain during retrobulbar blocks. Considering the importance of compliance, reducing anxiety and premedication may be considered, particularly in high-risk patients (VASA score > 4).