Comparing outcomes of local and regional anesthesia in vitreoretinal surgery: A systematic review and network meta-analysis.

We systematically review and compare the available evidence on the various types of regional anesthesia and topical anesthesia (TA) in vitreoretinal surgery and evaluate their respective outcomes. The principles outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for network meta-analysis were adhered to throughout this systematic review. The primary outcome measures were intraoperative pain score, the number of patients requiring additional anesthesia, and the number of adverse events. A preestablished protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), ID Number: (CRD42023449755). Fifty-three studies were screened in full text, resulting in 11 with nearly 1076 patients who met our criteria. Most patients had a retrobulbar block, and the average surgical time was 48 min. Regarding the pain score, sub-Tenon (ST) injection had the best results, and TA was significantly less effective when compared to ST and peribulbar (PB) injection (SMD=1.28 and 0.88, 95 % confidence interval (CI) to 2.46 and 0.18-1.58). ST had significantly less risk of requiring additional anesthesia when compared to all other techniques. Six studies reported adverse events, and PB had the least risk of an adverse event. Future research should continue to explore direct comparisons between each type.