ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
Subject(s)
Humans , Male , Aged , Oculomotor Nerve Diseases/etiology , Blindness/etiology , Anesthesia, Local/methods , Midazolam/administration & dosage , Fentanyl/administration & dosage , Phacoemulsification/methodsABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
We evaluated ten ptotic eyes of two hundred thirty eight eyes which had a peri bulbar anesthesia in aspects of sex, age and type of operation. Also we clinically evaluated the degree of ptosis, the function of levator muscle and postoperative interval to recovery of ptosis. The results were as follows: 1. Ptosis developed in 10 eyes (4.2%). Sex distribution was 8 females (80.0%) and 2 males (20.0%), and age distribution was from 44 to 83 years old. 2. At the postoperative 1 day, the most common degree of ptosis was severe form (60.0%), followed by mild form (30.0%) and moderate form (10.0%). In the function of levator muscle, 5 eyes (60.0%) were fair, followed by poor (30.0%) and good (20.0%). 3. The postopertive interval to recovery of ptosis was from 2 to 60 days, and then 5 eyes (50.0%) were Group II, followed by Group I (30.0%) and Group Ill (20.0%).
Subject(s)
Aged, 80 and over , Female , Humans , Male , Age Distribution , Anesthesia , Sex DistributionABSTRACT
In order to compare the influence of retrobulbar and peribulbar anesthesia technique to the change of intraocular pressure(IOP), we measured the IOP sequentially in 40 eyes of 40 patients(retrobulbar group: 20 eyes, peribulbar group: 20 eyes). The intraocular pressure was checked at one hour prior to operation, just after application of Honan apparatus with 30 mmHg for 30 minutes, just after the injcetion of anesthetics with technique retrobulbar and with peribulbar technique, and after digital massage for 5 minutes. Injected volume of anesthetics was 3 ml in retrobulbar technique and 6 ml in peribulbar technique. In retrobular group, the IOP mean was 16.55 mmHg at one hour prior to operation, 10.96 mmHg just after Honan application, 17.36 mmHg just after the injection of anesthetics and 10.38 mmHg after digital massage. In peribulbar group, the IOP mean was 16.97 mmHg at one hour prior to operation, 11.08 mmHg just after Honan application, 18.11 mmHg just after the injection of anesthetics and 11.31 mmHg after digital massage. The mean increase of IOP after the injection of anesthetics was 6.40 mmHg in retrobulbar group and 7.03 mmHg in peribulbar group. There was no statistical difference in the change of IOP between the two groups.(Student t-test, p>0.10).