Peribulbar tramadol, clonidine, and ropivacaine in blind and seeing painful eyes.

PURPOSE: To report on the treatment of painful eyes by peribulbar injection of tramadol, clonidine, and ropivacaine. METHODS: The authors treated a 72-year-old woman with chronic prephthisical pain in the left eye secondary to graft rejection after penetrating keratoplasty and an 81-year-old woman with severe ocular pain in her left eye for neovascular glaucoma secondary to an ischemic central vein occlusion. They were treated with a medial canthus injection of tramadol (100 mg/2 mL ampules), clonidine (0.15 mg/1 mL ampules), and 1% ropivacaine. RESULTS: Both injections were very well tolerated and neither transient nor lasting complications were reported. Complete pain relief was obtained in both patients within 1 day and was maintained throughout the follow-up (11 months and 7 months). CONCLUSIONS: Peribulbar tramadol, clonidine, and ropivacaine injection may represent a safe and effective treatment modality in the management of chronic ocular pain.

Truncal anaesthesia of the maxillary nerve for outpatient surgically assisted rapid maxillary expansion.

We present our experience of transcutaneous truncal anaesthesia of the maxillary nerve in association with transmucosal anaesthesia of the sphenopalatine ganglion in surgically assisted rapid maxillary expansion. Twelve patients with a skeletal transverse discrepancy of the maxilla were treated in our department from 1994 to 1995. Maxillary transcutaneous nerve block was done with a Quincke 8 cm spinal needle together with transmucosal anaesthesia of the sphenopalatine ganglion. Mepivacaine without adrenaline and sodium bicarbonate 1/10 was used for truncal anaesthesia and lidocaine-prilocaine cream for transmucosal anaesthesia. A Le Fort I osteotomy, lateral nasal wall osteotomy, pterygomaxillary osteotomy, and a palatal osteotomy were done for all patients before the maxillary expansion. Total anaesthesia of the maxillary area facilitated the operations and appreciably reduced the amount of postoperative pain. The ease of achieving effective anaesthesia before and after operation and the absence of side-effects make this form of anaesthetic particularly useful in surgically assisted rapid maxillary expansion.

Sedation with ketamine during cataract surgery.

PURPOSE: To evaluate the cardiovascular and ocular effects of a low-dose sedation-analgesia regimen in cataract surgery. SETTING: Department of Ophthalmology, University of Udine, Udine, Italy. METHODS: Eighty patients were randomly assigned to two groups. The first was treated with droperidol 0.03 mg/kg, diazepam 0.06 mg/kg, ketamine 0.3 mg/kg; the second (control), with the same drugs except for ketamine. Heart rate, arterial pressure, and intraocular pressure (IOP) in the fellow eye were measured before and 3 minutes after injection of the sedative mixture. The anesthetic block was then performed. RESULTS: Heart rate increased in both groups by about 5%. Systolic arterial pressure fell by 15.6 mm Hg +/- 22.3 (SD) in the ketamine group and by 31.7 +/- 17.3 mm Hg (P < .005) in the control group. Intraocular pressure fell in the two groups by 5.24 +/- 2.8 mm Hg and 4.5 +/- 2.5 mm Hg, respectively. None of the ketamine-treated patients reported pain during the administration of anesthesia or postoperatively. Eighty percent of the control group reported pain. In the early postoperative period, no episodes of nausea, emesis, or hallucination were reported. CONCLUSION: In a regimen with other drugs, ketamine did not influence IOP and enabled comfortable completion of anesthesia and surgery.