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.

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.

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.

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. .

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.