The efficacy of triamcinolone acetonide peribulbar injection combined with vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment / 中国医师杂志

Objective:To investigate the clinical efficacy of triamcinolone acetonide peribulbar injection combined with vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment (RRD-CD).Methods:This study was a retrospective case series study. Nineteen cases (19 eyes) with RRD-CD who had undergone pars plana vitrectomy at the Dalian No.3 People′s Hospital were analyzed. All the cases received 20 mg triamcinolone acetonide peribulbar injection within 3 to 7 days before surgery. The severity of patient′s uveitis was assessed before and after peribulbar injection of triamcinolone acetonide. Best corrected visual acuity (BCVA) and intra ocular pressure (IOP) before and after surgery, the area of retinal detachment, the rate of retinal reattachment, the rate of recurrent retinal detachment and surgical complications were analyzed. Patients′ blood pressure and blood glucose levels were also monitored.Results:19 patients were followed up for (13.1±1.5)months. The severity of uveitis reduced to different extents compared with preoperative condition. The IOP was (8.73±3.38)mmHg before injection and (10.95±2.46)mmHg after injection, and the difference was statistically significant ( t=-7.571, P=0.027). The choroid detachment range was 4-12(9.37±2.69)sites before injection, and 0-11(4.63±4.10)sites after injection, and the difference was statistically significant ( Z=-3.834, P=0.001). Compared with the preoperative results, the BCVA increased in 12 patients, unchanged in 5 cases and decreased in 2 cases. In the final follow-up of 18 patients with retinal reattachment, 17 eyes underwent a single operation, 2 eyes had recurrent retinal detachment, and 1 eye had retinal reattachment after a second operation. There were no significant difference in blood glucose and blood pressure before and after injection (all P>0.05). There were no other complications besides temporarily elevated IOP and cataract. Conclusions:Vitrectomy combined with triamcinolone acetonide peribulbar injection is effective and safe for patients with RRD-CD.

Comparative study to assess the effect of ropivacaine and a mixture of lidocaine and bupivacaine on intraocular pressure after peribulbar anesthesia for cataract surgery

Purpose: To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post?block intraocular pressure (IOP). Methods: A one?year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40� 70 years of age) planned for small?incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single?site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time?points: before block (control), 1?, 5?, and 15?minute post?block with a tonometer. Results: The 1?minute post?block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1?minute post?block IOP was significantly less in the ropivacaine group. The 5? and 15?min post?block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine?bupivacaine group and baseline (control) ropivacaine values. Conclusion: The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small?incision cataract surgery can be a suitable alternative to the lidocaine朾upivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine朾upivacaine combination.

A comparison of sub-tenon block with peribulbar block in small-incision cataract surgery

Purpose: To compare the efficacy and safety of sub?tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small?incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub?tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub?tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.

Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement

Purpose: To explore the various globe salvaging treatment strategies for patients with coronavirus disease 2019?associated mucormycosis (CAM). Methods: This was a prospective interventional analytical study conducted at a Medical College in rural India. A total of 84 patients of CAM admitted between May 2021 and August 2021 were enrolled for the study. Patients with histologically proven CAM with clinical and/or radiological evidence of orbital involvement were divided into three treatment categories based on the site and extent of the lesion. Re?assessment was performed after 7 days. For patients who worsened with the primary approach, orbital exenteration was considered based on a Sion Hospital Scoring System. A novel approach to intra?orbital anti?fungal therapy, site?centered peri?bulbar injection of amphotericin B (SCPeriAmB), was also explored. All the patients were followed up for at least 3 months. Convenience sampling with descriptive statistics was used. Results: Six patients had to finally undergo exenteration by the end of the study period. The rest of the patients were reported to be stable or improved. No mortalities were reported on delaying the exenteration. No adverse events were noted in patients who were given SCPeriAmB. Conclusion: Globe salvaging treatment options should be advocated as a primary approach in patients with CAM. Site?centered peri?bulbar injections can be considered as an approach for delivering intra?orbital anti?fungal therapy in selected patients

A prospective comparison of the efficacy of 0.5% bupivacaine vs 0.75% ropivacaine in peribulbar anesthesia for vitreoretinal surgery

Purpose: To date, there is no information on the comparison of the effect of 0.5% bupivacaine with 0.75% ropivacaine solution for vitreoretinal surgery. The aim of the study was to compare the efficacy of 0.5% bupivacaine with 0.75% ropivacaine in peribulbar anesthesia for vitreoretinal surgery. This was a prospective randomized double-blinded observational study in a hospital setting. Sixty patients planned for vitreoretinal surgery were randomized into two groups based on the peribulbar injection administered either with 0.5% bupivacaine or 0.75% ropivacaine solution, as Group B (n = 30) and Group R (n = 30), respectively. Time of onset of analgesia, akinesia, and the need for supplemental anesthesia were noted. Student's t-test or Mann-Whitney U test were used for comparing continuous variables and Chi-square or a Fischer exact test were used as appropriate for comparing two proportions. Results: The patients in Group R showed an earlier onset of both, analgesia (1.97 min vs. 2.10 min, P = 0.002) and akinesia (2.77 min vs. 4.20 min, P < 0.001) compared with the patients in Group B. The efficacy of the block attained was Grade 5 (adequate anesthesia and akinesia without supplementation) in about 97% of the patients in Group R while only 90% in Group B. However, the differences between the groups for the efficacy of the block were not statistically significant (P = 0.301) neither for Grades 5 nor for Grade 4 and 3 (P = 1.00 for both). The onset of postoperative pain was similar for both groups (P = 1.00). Conclusion: We concluded that 0.75% ropivacaine is a better choice of local anesthetic solution for patients undergoing primary vitreoretinal surgery compared with 0.5% bupivacaine.

To Compare the Effectiveness of Sub-Tenon’s Anesthesia with Peribulbar Anesthesia in Patients Undergoing Manual Small-incision Cataract Surgery

Background: Blindness due to cataract presents an enormous problem in terms of human morbidity, economical loss, andsocial burden. Retrobulbar anesthesia was commonly used for cataract surgery. Rare but serious complications led manyophthalmologists to replace retrobulbar with peribulbar anesthesia. However, even peribulbar anesthesia does not eliminatethe serious complications totally. These concerns have led to increased use of blunt needle sub-Tenon’s block over the sharpneedle blocks.Materials and Methods: 200 cases were selected, of which 100 were in the sub-Tenon’s group and the remaining 100 werein the peribulbar group. The efficacy of anesthesia between the two groups was compared in terms of analgesia at variousintervals, akinesia of the globe and eyelids attained after the block. They were graded on a subjective scale and recorded.Minor complications such as chemosis, sub-conjunctival hemorrhage, and rise in increased intraocular pressure (IOP) werealso compared and analyzed.Results: Sub-Tenon’s anesthesia provided better analgesia than peribulbar anesthesia although the akinesia was poorer thanthe latter. Minor complications such as sub-conjunctival hemorrhage were more in sub-Tenon’s group while instantaneous risein IOP was more in peribulbar group. The incidence of chemosis was almost comparable in both the groups.Interpretation and Conclusion: Sub-Tenon’s anesthesia is recommended as a safe and effective alternative to peribulbaranesthesia for small-incision cataract surgery as it provides good analgesia, adequate akinesia, and rare minor complications.

Evaluation of the effect and safety of dexmedetomidine as an additive to local anesthesia in peribulbar block for vitreoretinal surgery

Purpose: We conducted a prospective, randomized study to evaluate the efficacy of dexmedetomidine as an additive to peribulbar block for vitreoretinal surgery in terms of onset time of block, hemodynamic stability profile, patient comfort, and surgeon satisfaction. Methods: One hundred patients of American Society of Anesthesiologists grade 1 and 2 scheduled for vitreoretinal surgery were randomly assigned into two groups: control group (n = 50) received lignocaine bupivacaine block, and Dex group (n = 50) received lignocaine bupivacaine plus 20 ?g dexmedetomidine peribulbar block. Information regarding time for onset of block, hemodynamic data, visual analog scale for pain, sedation levels, total duration of surgery, and surgeon satisfaction levels were collected. Results: All the demographic characteristics including age, gender, American Society of Anesthesiologists grade, onset of anesthesia, and duration of surgery were comparable in both groups. At the baseline, there was no statistically significant difference in heart rate, mean arterial pressure, diastolic blood pressure, and respiratory rate between the two groups, with a difference noted in systolic blood pressure at the baseline. There was significant difference noted in the systolic blood pressure and mean arterial pressure at different time intervals with a decreasing trend as time progressed. The mean sedation score was significantly higher in the Dex group than that in the control group. The surgeon satisfaction was higher in the Dex group than that in the control group. Conclusion: Dexmedetomidine is a useful and safe drug in combination with lignocaine bupivacaine in peribulbar for vitreoretinal surgery as it maintains hemodynamic stability and provides sedation, which enables full cooperation and potentially better operating conditions.

Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block - Case report / Amaurose e paralisia do III e do VI pares cranianos contralaterais após bloqueio peribulbar - relato de caso

Abstract Background and objectives: Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. Case report: Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. Conclusions: During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.

Resumo Justificativa e objetivos: A anestesia peribulbar surgiu como uma opção mais segura quando comparada com o bloqueio retrobulbar intraconal. Ainda assim, a anestesia peribulbar não pode ser considerada isenta de riscos. Inúmeras complicações foram descritas quando da aplicação dessa técnica. O presente relato tem como objetivo descrever um caso raro caracterizado por amaurose e paralisia contralaterais quando da tentativa de se fazer a anestesia peribulbar. Relato de caso: Paciente masculino, 75 anos, estado físico ASA II, submetido à facectomia por facoemulsificação com implante de lente intraocular. Sedado com fentanil e midazolam e submetido a APB. Não houve intercorrências durante a cirurgia. Após o término do procedimento o paciente relatou ausência de visão no olho contralateral. Foram observadas acinesia da musculatura inervada pelo III e VI pares cranianos, ptose palpebral e pupilas de tamanho médio, não responsivas ao estímulo luminoso. Após quatro horas da anestesia, houve recuperação completa da visão, da movimentação das pálpebras e do globo ocular não operado. Conclusões: Durante a APB, estruturas localizadas no espaço intraconal podem ser atingidas acidentalmente levando a complicações como a descrita no relato acima. O respeito às diretrizes técnicas e o uso de agulhas com o tamanho adequado podem reduzir o risco de tal complicação, mas não de forma completa.

Perioperative Hypersensitive Reaction to Hyaluronidase.

Hypersensitive reactions are one of the problems faced by Anaesthesist.In this case report we present a case who developed hypersensitive reaction following a peribulbar block with hyaluronidase.In this study we stress to perform test dose for hyaluronidose especially if non recombinant preparations are used.

Purtscher‑like retinopathy: A rare complication of peribulbar anesthesia.

Purtscher and Purtscher‑like retinopathy is a distinctive retinal syndrome characterized by ischemic retinal whitening in a peripapillary pattern. We report a case of Purtscher‑like retinopathy in a healthy 64‑year‑old man after a routine peribulbar anesthetic injection for cataract surgery. Although peribulbar anesthesia is considered to be a safer alternative to retrobulbar anesthesia, it has been associated with unusual but grave complications including central retinal artery occlusion.

Hyaluronidase hypersensitivity: A rare complication of peribulbar block.

Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight‑threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later.

Double Trouble: A Case of Local Anaesthetic Toxicity Followed By Tension Pneumothorax in a Patient of Marfan Syndrome.

Spontaneous pneumothorax in patients with Marfan syndrome is common. Even a small pneumothorax can become a tension pneumothorax under positive pressure ventilation. Sometimes anaesthesiologists have to cater to more than one complication intraoperatively. Thorough knowledge of the subject and availability of monitors and anaesthesiologist in the operation theater as in general anaesthesia during locoregional anaesthesia is mandatory to avoid occurrence of catastrophy.

Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation.

Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self‑resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.

Analysis of ocular cyclotorsion in lying position after peribulbar block and topical anesthesia / Análise da ciclotorção ocular em posição supina após bloqueio peribulbar e anestesia tópica

Purpose: Evaluate the magnitude of cyclotorsion during cataract surgery in patients with indication for intraocular toric lenses comparing the results after peribulbar and after topical anesthesia. Methods: This prospective study comprised 112 eyes that underwent cataract surgery with implantation of toric intraocular lens by topical anesthesia or peribulbar block. We estimated how many degrees of cyclotorsion occurred after topical anesthesia and peribulbar block with the patient in supine position. A tag was performed in the position of 180 degrees of the right eye and zero degrees of the left eye, with the patient seated. Afterwards, it was requested a change to the supine position and then a new dial in 180 and zero degrees respectively from right and left eye were made. Results: The current study demonstrated that patients submitted to cataract surgery with implantation of toriclens under local anesthesia showed approximately 6.89 degrees of incyclotorsion (82 eyes) and 6.93 degrees of excyclotorsion (38 eyes) and a mean of cyclotorsion of 6.91 degrees. Patients undergoing peribulbar block showed 5.68 degrees of incyclotorsion (73 eyes) and 4.81 degrees of excyclotorsion (47 eyes) and a mean of cyclotorsion of 4.92 degrees. Conclusion: Through the study we can see that the movement of incyclotorsion in patients undergoing peribulbar anesthesia was lower when compared to topical anesthesia. This is relevant since the greater the incyclotorsion, the lower the predictability of the surgery and the lower the chance of obtaining excellent results in the final refractometric. .

Objetivo: Avaliar a magnitude da ciclotorção durante a cirurgia de catarata em pacientes com indicação de lentes intraoculares tóricas comparando os resultados após o bloqueio peribulbar e após a anestesia tópica. Métodos: Esse estudo prospectivo compreende 112 olhos que foram submetidos à cirurgia de catarata com implante de lente intraocular tórica por meio de anestesia tópica ou bloqueio peribulbar. Foram estimados quantos graus de ciclotorção ocorreu após a anestesia tópica e após o bloqueio peribulbar, com o paciente em posição supina.Foi realizada uma marcação na posição de 180 graus do olho direito e zero grau do olho esquerdo, com o paciente sentado, em seguida,houve uma mudançade posição para decúbito dorsal, sendo realizadas novas marcações em 180 e zero graus dos olhos direito e esquerdo, respectivamente. Resultados: O presente estudo demonstrou que pacientes submetidos à facoemulsificação com implante de lente tórica com anestesia tópica apresentaram aproximadamente 6.89 graus de inciclotorção (82 olhos) e 6,93 graus de exciclotorção (38 olhos) com uma média de ciclotorção de 6.91 graus. Já os pacientes submetidos à anestesia peribulbar apresentaram 5.68 graus de inciclotorção(73 olhos) e 4,81 graus de exciclotorção (47 olhos) com uma média de ciclotorção de 4,92. Conclusão: Através do estudo podemos observar que o movimento de inciclotorção em pacientes submetidos à anestesia peribulbar foi menor quando comparado ao da anestesia tópica. Isso se torna relevante uma vez que, quanto maior for a inciclotorção, menor a previsibilidade da cirurgia e menor a chance de obtenção de excelência nos resultados refratométricos finais. .

Avaliação da pressão intraocular e exoftalmometria pré e pós-bloqueio peribulbar em pacientes submetidos à facectomia / Intraocular pressure and exotalmometer evaluation before and after peribulbar anaesthesia in cataract surgery

OBJETIVOS:Comparar os efeitos sobre a PIO após o bloqueio peribulbar com lidocaína e bupivacaína em pacientessubmetidos à cirurgia de facectomia com implante de lente intraocular (LIO), bem como avaliar indiretamente e comparar a distribuição dos anestésicos na órbita com a medida da exoftalmometria antes e após a anestesia peribulbar. A bupivacaína e a lidocaína são anestésicos locais que rotineiramente têm sido utilizados para realização de bloqueio peribulbar. Sabe-se que a pressão intraocular (PIO) é um fator importante no pré-operatório imediato da cirurgia de catarata para evitar possíveis complicações como perda vítrea e hérnia de íris. MÉTODOS: Cinquenta pacientes de ambos os sexos, com idade entre 48 e 93 anos, com avaliação pré-anestésica ASA I e II, foram randomizados após a conclusão da pesquisa em 2 grupos: Grupo 1: os que receberam lidocaína e Grupo 2: os que receberam bupivacaína. A medida da PIO foi realizada e analisada em 4 momentos: Antes da anestesia; 1 minuto após o bloqueio; 5 minutos após o bloqueio; 7 minutos após o bloqueio. Também foi avaliado a exoftalmometria antes e imediatamente após o bloqueio com exoftalmômetro de Luedde. RESULTADOS: Houve um aumento na medida da PIO com o bloqueio anestésico nos dois grupos comparados, porém não houve diferença estatisticamente significante no aumento da PIO quando comparada as duas drogas analisadas. Quando comparamos a exoftalmometria, identificamos que não houve diferença estatisticamente significante no aumento da proptose em relação aos dois grupos, isto é, os dois anestésicos quando comparados distribuem-se da mesma forma na cavidade orbitária. CONCLUSÃO: Não houve diferença na variação do aumento da PIO e da na variação da exoftalmometria entre os dois anestésicos comparados.

PURPOSE: To compare the effects of IOP after peribulbar anaesthesia with lidocain and bupivacain for cataract surgerywith intraocular lens implantation and evaluate exoftalmometer results after the same procedure. Bupivacain and lidocain are local drugs used for peribulbar anaesthesia. It is known that intraocular pressure (IOP) is an important factor for cataract surgery to avoid complications like vitreous loss and iris hernia. METHODS: Fifty male and female patients, between 48 and 93 years old, with ASA I and II evaluation before anaesthesia were recruted to participate for this study. We had 2 groups for the study. Group 1: lidocain patients and group 2: bupivacain patients. Intraocular pressure was measured in 4 different periods: before peribulbar anaesthesia, 1 minute, 5 minutes and 7 minutes after. We also performed exoftalmometer evaluation before and right after peribulbar anaesthesia with Luedde exoftalmometer. RESULTS: There was higher IOP after peribulbar anaesthesia, but not significant when compared between both drugs. The exoftalmometer evaluation showed that both drugs are equal distributed in orbit and they both cause proptosis of the ocular globe. CONCLUSION: There was no difference comparing higher intraocular pressure or exoftalmometer evaluation between both drugs.

Prilocaína a 3% associada à felipressina na anestesia peribulbar de gatos / Prilocaine 3% associated with felipressin peribulbar anesthesia in cats

O objetivo deste trabalho foi avaliar os efeitos da prilocaina associada à felipressina na anestesia peribulbar em gatos. Foram utilizados oito gatos adultos, machos e fêmeas, com peso entre 2 e 3 kg. Cada animal recebeu clorpromazina (1,0 mg.kg-1 por via intramuscular) como medicação pré anestésica e propofol (3,0 mg.kg-1 por via intravenoso) para indução anestésica. Foi introduzida uma agulha hipodérmica de 0,38 x 13 mm moldada manualmente até atingir a forma de "L" na porção superior da cavidade orbitária em direção ao fórnice e administrada prilocaína a 3% com vasoconstritor na dose de 5 mg.kg-1. Foi observada proptose após uma média de 2,28 ± 1,52 minutos, e este efeito durou em média 75,22 ± 26,99 minutos. Também ocorreu perda do reflexo corneano após 3,00 ± 1,69 minutos e sua duração foi de 73,75 ± 17,98 minutos em média. A prilocaína 3% com vasoconstritor manteve o globo ocular concêntrico, sem nistagmo e aboliu os reflexos corneanos sem causar efeitos colaterais.

The purpose of this study was to verify the effects of prilocaine 3% associated to felypressin for peribulbar anesthesia in cats. Eight adult cats, male and female, weighing between 2 and 3 kg, received chlorpromazine (1.0 mg.kg-1, intramuscular) and propofol (3.0 mg.kg-1, intravenously). While, prilocaine at 3% (5.0 mg.kg-1) was administered by using an L-shape hypodermic needle (0.38 x 13 mm), which was introduced in the upper portion of the orbital cavity towards the fornix. The onset of proptosis was observed in 2.28 ± 1.52 minutes and lasted 75.22 ± 26.99 minutes. The loss of the corneal reflex occurred after 3.00 ± 1.69 minutes and lasted 73.75 ± 17.98 minutes. It can be concluded that 3% prilocaine with felypressin solution induces centralization of the eyeball without nistagmus and abolition the corneal reflexes without causing any collateral effects in cats.

Anestesia peribulbar com ropivacaína como alternativa ao bloqueio neuromuscular para facectomia em cães / Peribulbar anesthesia with ropivacaine as an alternative to neuromuscular blocking agents for cataract surgery in dogs

Desenvolveu-se uma técnica de bloqueio peribulbar comparando-a à técnica de anestesia oftálmica com bloqueio neuromuscular parcial em cães submetidos à facectomia extracapsular. Doze cães, de diferentes raças, foram alocados em dois grupos (G1 e G2) e anestesiados com acepromazina (0,05mg/kg, IV) e propofol (5mg/kg, IV) e mantidos com isofluorano sob ventilação espontânea. Os cães do G1 receberam o bloqueio peribulbar com ropivacaína 0,75 por cento, e os do G2 o bloqueio neuromuscular parcial com brometo de pancurônio (0,01mg/kg, IV). Utilizaram-se, como parâmetros comparativos, escores de posicionamento do globo ocular, controle do reflexo oculocardíaco e pressão intraocular (mmHg). Foi possível propor uma técnica eficaz para cães baseando-se na técnica de bloqueio peribulbar posterior realizada no homem. Em ambos os grupos, o globo ocular permaneceu centralizado. Não ocorreram alterações eletrocardiográficas atribuídas ao reflexo oculocardíaco. Houve redução significativa da pressão intraocular em G1 após o bloqueio (10,7±0,6 e 14,7±0,6). Conclui-se que o bloqueio peribulbar proporcionou condições cirúrgicas apropriadas para a realização da facectomia, com a vantagem de promover bloqueio sensitivo do olho.

A peribulbar block technique was developed and its clinical efficacy was compared with neuromuscular blockade in dogs undergoing cataract surgery. Twelve dogs of different breeds were randomly and equally allocated in two groups. After given acepromazine (0.05mg/kg, IV), anesthesia was induced with propofol (5mg/kg, IV) and maintained with isoflurane in oxygen during spontaneous breathing. A peribulbar block with 0.75 percent ropivacaine was performed in G1 dogs while partial neuromuscular blockade with pancuronium (0.01mg/kg IV) was provided in G2 dogs. Globe position scores, oculocardiac reflex, and intra-ocular pressure (mmHg) were evaluated at pre-defined intervals during surgery. Peribulbar blocks were successful performed according to posterior peribulbar block described in humans. In both groups, the globe was centralized and globe position scores did not differ between groups. The intra-ocular pressure was significantly lower in G1 after the block (10.7±0.6 vs 14.7±0.6). There were no electrocardiographycal changes attributed to the oculocardiac reflex. In conclusion, satisfactory surgical conditions were provided by the peribulbar block. This technique can be used as an alternative to the use of neuromuscular blocking agents in dogs undergoing cataract surgery, with the advantage of providing analgesia of the eye.

Peribulbar anesthesia for cataract surgery: Effect of lidocaine warming and alkalinization on injection pain, motor and sensory nerve blockade.

Aim: To compare self-reported pain and efficacy of warmed, alkalinized, and warmed alkalinized lidocaine with plain 2% lidocaine at room temperature for peribulbar anesthesia in cataract surgery. Materials and Methods: Through a prospective, single-blinded, randomized, controlled clinical trial 200 patients were divided into four groups. They received either lidocaine at operating room temperature 18°C, control group (Group C), lidocaine warmed to 37°C (Group W), lidocaine alkalinized to a pH of 7.09 ± 0.10 (Group B) or lidocaine at 37°C alkalinized to a pH of 6.94 ± 0.05 (Group WB). All solutions contained Inj. Hyaluronidase 50 IU/ml. Pain was assessed using a 10-cm visual analog score scale. Time of onset of sensory and motor blockade and time to onset of postoperative pain were recorded by a blinded observer. Results: Mean pain score was significantly lower in Group B and WB compared with Group C (P < 0.001). Onset of analgesia was delayed in Group C compared with Group B (P = 0.021) and WB (P < 0.001). Mean time taken for the onset of complete akinesia and supplementation required for the block was significantly lower in Group B. Time of onset of pain after operation was significantly earlier in Group W compared with Group C (P = 0.036). Conclusion: Alkalinized lidocaine with or without warming produced less pain than lidocaine injected at room temperature. Alkalinization enhances the effect of warming for sensory nerve blockade, but warming does not enhance alkalinization, in fact it reduces the efficacy of alkalinized solution for blocking the motor nerves in the eye.

Effect of peribulbar anesthesia on intraocular pressure and ocular pulse amplitude / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of peribulbar anesthesia on intraocular pressure(IOP)and ocular amplitude pulse(OPA).METHODS: Thirty-two consecutive adult patients with monocular cataract enrolled in this study. IOP and OPA were measured with dynamic contour tonometer(DCT)before and 3, 10 minutes after administration of lidocaine anesthesia. Data were analyzed with software SPSS 11.5.RESULTS: The IOP remained stable in the injected eyes and the non-injected eyes after administration of lidocaine anesthesia. The OPA was significantly decreased after injection of anesthesia agent in the injected eyes. The OPA in the non-injected eyes increased significantly 3 minutes after injection of the anesthesia agent, returning to preinjection level 10 minutes after the injection.CONCLUSION: Peribulbar anesthesia leads to decrease of OPA and shows no effect on IOP in the injected eyes.