Comparison of metal and flexible sub-Tenon cannulas

Riad, Waleed; Ahmad, Nauman; Kumar, Chandra M.

doi:10.1016/j.jcrs.2012.03.035

Cited by 9 publications

(4 citation statements)

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“…Different types of cannulas are currently used for STB, but ST cannula is considered the gold standard. [1314] Hence, the efficacy of all other cannulas is compared to the ST cannula. Mather compared a simple 20-gauge intravenous cannula to ST and has found it equally effective.…”

Section: Discussionmentioning

confidence: 99%

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

Al-Motowa

Ahmad

Khandekar

et al. 2016

Middle East Afr J Ophthalmol

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PURPOSE:To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery.METHODS:This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant.RESULTS:There were sixty patients in each group. The age between groups was not statistically different (P = 0.4). The body mass index was higher in the ST group compared to the OT group (P < 0.001). The akinesia score at 5 and 10 min did not differ between groups (P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups (P = 0.1 and P = 0.06, respectively). There were six patients with mild chemosis and redness in the OT group and 15 patients in the ST group.CONCLUSION:An OT cannula is equally effective as the conventional Steven's cannula for delivering STB anesthesia before cataract surgery.

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Section: Discussionmentioning

confidence: 99%

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

Al-Motowa

Ahmad

Khandekar

et al. 2016

Middle East Afr J Ophthalmol

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“…Onset of akinesia was shorter in alkalanised preparation of lidnocaine [36] . Akinesia was less with a metal subtenon canula compared to flexible medium or flexible posterior cannulas [37] . In a hospital-based randomized comparative interventional study of uncomplicated cataract surgery who received either peribulbar block or posterior sub-tenon block, Igana et al [38] reported that both routes of administering anesthetic substances is comparable in providing adequate akinesia and analgesia for cataract surgery with minimal complications, and both techniques are effective and safe.…”

Section: Akinesiamentioning

confidence: 85%

Local Anaesthesia in Cataract Surgery

Reddy

Thevi

2017

International Journal of Ophthalmic Research

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nerves of the cornea and the conjunctiva (long and short ciliary nerves, nasociliary nerves). This technique eliminates the possible complications of injectable anesthesia. However, it does not eliminate pain sensitivity of the iris, the zonule, and the ciliary body which is achieved by intracameral technique of anesthesia with preservative free 1% lidocaine. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but there is a possibility of getting an allergic reaction. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma. INTRODUCTIONThe ideal anaesthesia would be one that provides adequate pain relief during surgery and postoepratively, be easy to administer and have minimal complications. For doing cataract surgery, the anaesthesia could be local or general. Majority of cataract patients are operated under local anaesthesia (infiltration, topical, intracameral). The infiltration anaesthesia is given as retrobulbar or peribulbar or subTenon's block. Carl Koller first used cocaine as a topical anaesthetic for eye surgery in 1884 [1] . The general anaesthesia has its own complications in elderly cataract patients and most of them may have diabetes or hypertension or heart diseases or combination of them. No need of fasting before or after surgery, no need of intubation, no need of using any systemic medications are the advantages of local anaesthesia. However, cataract in children, patients with parkinsonism, deaf mute patients, mental retardation patients, patients ABSTRACTThere has been a significant evolution in surgical technique of cataract extraction. The technical advances in phaco machines, phacotips, and availability of ophthalmic viscoelastic devices have played a great role in cataract surgery to be faster and more controlled now than before. Similarly, local anesthesia techniques in cataract surgery have also advanced significantly from retrobulbar, peribulbar, sub-Tenon's, to topical anaesthesia. Even though, the sub-Tenon's anesthesia technique reduced the risk of complications of peribulbar/ retrobulbar anesthesia but the technique is still associated with a possibility of damage to optic nerve, retrobulbar hemorrhage, and ocular muscle injury. Topical anesthesia is used to block the afferent EDITORIAL

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“…It is assumed in the reported cases in the literature, that rigid metal posterior cannulas were used. Riad et al 5 compared flexible cannulas with rigid ones for STA with comparable akinesia results and presumably better safety. A low-volume sub-Tenons such as 1.5 mL has been indicated to have ‘good anaesthesia’ and ‘varying akinesia’ but no comparable data with the conventional larger volumes 6…”

Section: Descriptionmentioning

confidence: 99%

Retrobulbar haemorrhage following routine sub-Tenon’s anaesthetic in a non-anticoagulated patient

Javaid

Cochrane

2020

BMJ Case Rep

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► Use of a rigid metal posterior cannula is associated with higher rate of complications. ► Shorter, flexible cannula reduces incidence of chemosis. ► Lower volume of anaesthetic agent is safer. ► Anticoagulation may have an effect on the response to local anaesthetic injection. DesCripTionA 72-year-old myopic male patient was due to undergo routine cataract surgery for his right eye. He had undergone no previous eye surgery and preoperative measurements were unremarkable. Preoperative visual acuity (VA) for the right eye (RE) was counting fingers (unaided), 6/18 (best corrected visual (BCV) acuity) and 6/18 (unaided) and 6/12 (BCV) for the left eye (LE). Axial length measured 23.64 mm and Anterior Chamber (AC) depth was 3.38 mm for the right eye. The left eye measured 23.64 mm with an AC depth of 3.37 mm. He had a history of primary open angle glaucoma and was treated with g. Travoprost 0.004% one drop once daily in both eyes, brinzolamide 1% one drop two times a day in both eyes for over 10 years. Of significance, slit lamp examination showed nuclear sclerotic cataract in both eyes, cup to disc ratio was 0.6 on the right and 0.7 on the left. Intraocular pressure (IOP) measurements preoperatively were 12 mm Hg in both eyes. Blood pressure on admission was 158/87 and PO medication included omeprazole 10 mg OD, and naproxen 250 mg PRN, which the patient reports he did not use regularly.Prior to surgery, an experienced ophthalmic surgeon administered 5 mL lidocaine 2% into the sub-Tenon's space with a single-use 19G curved, blunt-end, sub-Tenons cannula. Westcott scissors were used to dissect the inferonasal conjunctiva to access the sub-Tenons space. The patient reported no discomfort immediately postprocedure and there was minimal chemosis.On transfer to theatre, approximately 5 min following anaesthetic, it was noted the eye had become tense and there was proptosis with resistance to retropulsion. On further clinical examination, retrobulbar haemorrhage was diagnosed and emergency lateral canthotomy performed releasing a large volume of blood with immediate resolution of proptosis (figure 1). IOP measurements taken 2 hours post canthotomy were recorded as 22 mm Hg. The patient was discharged and reviewed 2 days later; there was full range of eye movements, no proptosis and visual acuity was 6/18. IOP in the RE was 14 mm Hg. Further examination 3 weeks post canthotomy revealed a healed scar with no ectropion. IOP in the RE was 22 mm Hg and BCV unchanged at 6/18. A systematic review comparing topical versus sub-Tenon's anaesthesia (STA) in cataract surgery found that the latter was associated with: better analgesia; better operating conditions; reduced rate of posterior capsular tear; reduced rate of vitreous loss. 1 Serious complications are reported as 2.5 times more likely to occur with peribulbar/retrobulbar anaesthesia than sub-Tenons anaesthetic. 2 Previous cases of retrobulbar haemorrhage have been associated with anticoagulant use 3 or large axial length. 4 It is assumed in the reported cases in the litera...

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Comparison of metal and flexible sub-Tenon cannulas

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 9 publications

References 9 publications

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

Local Anaesthesia in Cataract Surgery

Retrobulbar haemorrhage following routine sub-Tenon’s anaesthetic in a non-anticoagulated patient

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