Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri‐operative outcome following retinal detachment surgery

Abstract

SummarySixty premedicated, ASA physical status I or II patients weighing . 25 kg scheduled for elective retinal detachment repair were randomly assigned to receive either peribulbar block with 10 ml of 0.25% bupivacaine (block group) or intravenous morphine 150 mg.kg 21 (morphine group), prior to the induction of general anaesthesia (n 30 in each group). Patients were evaluated for intraoperative oculocardiac reflex , peri-operative pain relief, recovery from anaesthesia and postoperative nausea and vomiting. Apart from significantly reducing the incidence of oculocardiac reflex (30% vs. 70%, p 0.0019), peribulbar bupivacaine also attenuated the severity of the reflex. Postoperative pain relief was superior in the block group. More block group patients had the maximum recovery score in the immediate postoperative period (80% vs. 27%, p , 0.0001) and they achieved complete recovery significantly faster than the morphine group (17.3 (14.7) min vs. 66.7 (29.7) min, p , 0.0001). The incidence (40% vs. 77%, p 0.004) and severity of postoperative nausea and vomiting were significantly less in the block group. In summary, peribulbar bupivacaine, when administered together with general anaesthesia, attenuated oculocardiac reflex, provided comparable intra-operative and superior postoperative analgesia, resulted in significantly earlier and better recovery from anaesthesia, and significantly reduced the incidence and severity of postoperative nausea and vomiting.

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

“…However, although results of that study 26 indicated 4 mL was appropriate for PBA, a volume of 3 mL was used in the present study because of 2 concerns: ensuring we did not exceed a bupivacaine dose of 2 mg/kg to avoid systemic toxicosis, [35][36][37][38][39][40][41] and maintaining a bupivacaine concentration > 0.25% because lower concentrations of the anesthetic may lead to decreased efficacy. 4,42,43 Given that distribution of the injectate around the optic nerve was only 90° to 180° in 3 of 6 PBA-treated eyes, it is possible that a larger volume (4 mL) was indicated for PBA. Addition of the contrast agent in the present study also may have affected distribution of the bupivacaine, but it was essential for the CT monitoring.…”

“…[1][2][3][4][5][6][7] Additionally, these techniques provide excellent extraocular muscle akinesia that can replace the use of neuromuscular blocking agents and avoid the need for positive pressure ventilation, both of which are often required for intraocular surgery. 1,[7][8][9][10] As with other regional anesthetic techniques, use of RBA and PBA may reduce the requirements for general anesthetic agents during surgery and thus reduce the adverse effects of these drugs.…”

“…[11][12][13] Finally, these techniques reduce the incidence of the oculocardiac reflex, which can result in severe bradyarrhythmias and, rarely, asystole. [3][4][5][6][14][15][16][17] In humans, RBA has been considered the criterionreferenced standard for provision of regional anesthesia during many ophthalmic procedures. It is achieved by injecting 2 to 5 mL of an anesthetic agent intraconally (inside the muscle cone created by the extraocular muscles).…”

The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery

“…Placement of a scleral buckle entails extensive dissection of the conjunctiva, Tenon's capsule and sclera, requiring repeated traction on extra-ocular muscles, leading to an increased incidence of the oculocardiac reflex and more postoperative pain [4]. In the study by Shende et al [1] the time to administration of first analgesic rescue medication was similar in the peribulbar and GA groups, which may have been due to the lower concentration of bupivacaine used (0.25%) and the use of long-acting opioid analgesia (morphine) in the GA group.…”

“…A high incidence of postoperative pain and postoperative nausea and vomiting (PONV) are attributed to increased intra-ocular pressure due to expansion of the gas bubble or tight buckling or encirclement, particularly when performed under general anaesthesia [1][2][3]. The reluctance to use local anaesthesia alone for vitreoretinal surgery may stem from the longer, more unpredictable and uncomfortable nature of such surgery [4].…”