The findings of a randomized controlled trial depicted that in peribulbar anesthesia for vitrectomy surgery, adding Ketorolac and Neostigmine to a low-dose local anesthetic mixture led to longer durations and delayed onsets of both sensory and motor blocks as well as extended time to first analgesic agent need. Investigators sought to evaluate the effectiveness and safety of adding Neostigmine and Ketorolac to a local anesthetic solution during vitrectomy.

A total of 50 adult subjects of both genders with physical status I or II as per the American Society of Anesthesiologists and scheduled for vitrectomy under regional anesthesia were incorporated. The peribulbar block was administered to all subjects using a single medial canthus injection therapy.

Overall, 25 subjects were given a combination of 4 mg/ml Ketorolac and 300 μg Neostigmine in the Neostigmine and Ketorolac (NK) group as an adjunct to 3.5 ml Bupivacaine (0.5%) and 2.5 ml Lidocaine (2%) solution consisting of 75 units of hyaluronidase. Neostigmine/Ketorolac was substituted with 1.5 ml of normal saline for the control (C) group.

The durations and onsets of both sensory and motor blocks were the major endpoints. Patient and surgeon satisfaction, adverse effects, hemodynamics, and time to first analgesic dosage were the secondary endpoints ascertained. The NK group's sensory and motor block onsets were substantially shorter than those of the C group. The NK group had considerably greater akinesia and anesthesia durations than the C group. Between the NK and C groups, there was a noticeable difference from the meantime to the first analgesic dosage.

Contrasted to the C group, the NK group experienced a greater rate of side effects even though it did not achieve clinical significance. The NK group had a much greater patient and surgeon satisfaction compared to the C group. Hence, Neostigmine/Ketorolac combination added to a low-dose local anesthetic mixture for peribulbar anesthesia during vitrectomy surgery was beneficial.