Simple effective regional technique for eye surgery

ABSTRACT

The study included 50 elderly cooperative unpremedicated patients undergoing peribulbar block for elective cataract extraction and intraocular lens implantation [ASA physical status I, II or 111]. The patients were assigned to one of the two groups according to the technique of peribulbar block used [n=25 per group] by random selection. Group I received local anesthetic mixture through a single transconjunctival infrotemporal approach. Group II received the block through a single transconjunctival medial approach. The injected anesthetic mixture was composed of equal volumes [5 ml each] of plain lignocaine 2% and plain bupivacaine 0.75% supplemented by 15 U/m1 hyaluronidase and 0.05 ml of 8.4% sodium bicarbonate that makes pH of the mixture around 6.5. Up to 10 ml of this solution was injected initially. This study assessed the injective volume [initial, supplementary and total volume used]. Motor block scoring system was done after initial and supplementary injections. Eye tension was reported after initial and supplementary injections and the overall quality assessment of the block by the surgeon, as well as patient satisfaction, together with any complication were reported. On conclusion, the ideal local anesthetic mixture for peribulbar block is that made from equal volumes of lignocaine and bupivacaine supplemented with 15 U/ml hyaluronidase and 0 05 ml of 8.4% sodium bicarbonate. The medial transconjunctival approach is easy to be performing by non-ophthalmologist, more comfortable to the patient and with minor complications