It is mandatory for the cosmetic surgeon to use local anesthesia in a safe and effective manner. Current trends to perform more procedures in the office setting necessitate that the surgeon become facile with achieving anesthesia while minimizing complications. In a related theme, the use of tumescence during liposuction deserves respect, despite the ease with which it is applied. Too many unnecessary complications occur as a result of its careless use, resulting in a mortality rate higher than expected for an elective cosmetic procedure. Our goal is to describe the necessary characteristics, pharmacokinetics, physiologic effects, and overall safety guidelines for use of local anesthesia and tumescence. In addition, we highlight risk factors, newer anesthetics, and new methods for pain control.

Brainstem anesthesia (BSA) is a rare but serious complication of the peribulbar block. Fewer than ten cases have been reported in the literature. We report a case of BSA after the peribulbar block for cataract surgery. The patient developed convulsion and respiratory arrest 5 min after injection of 7 ml of 2% lignocaine using a 25 ml (mm) length of 24 gauge (G) needle. The patient was successfully managed with prompt recognition and mechanical ventilation for about 1 h. Cataract surgery was performed 3 months after the adverse event. This time, the patient had an uneventful recovery. The patient was well at the 6-month follow-up.

Intravitreal implantation of Ozurdex (Allergan Inc., Irvine, CA, USA), a sustained-release dexamethasone implant, is a common practice in ophthalmology. Inadvertent intralenticular implantation of Ozurdex is a very rare complication. Herein, we report a case of accidental intralenticular Ozurdex implantation. During the intravitreal procedure, the patient moved his head vigorously which resulted in the said complication. He was followed up periodically with monitoring of intraocular pressure (IOP), best-corrected visual acuity, lens status, fundus, and macular edema status. He developed a posterior subcapsular cataract after about 5 months of the procedure. The cataract was removed around 6 months follow-up by phacoemulsification with anterior vitrectomy and implantation of a 3-piece posterior chamber intraocular lens in the ciliary sulcus. Macular edema had resolved by 3 months of Ozurdex implantation and the patient did not require a second intravitreal dose. He was well at 3 months follow up after cataract surgery.