Ophthalmic regional anaesthesia: A review and update

Abstract

Local anaesthetic techniques are increasingly popular for ophthalmic surgery. It is now being provided mainly by anaesthesiologists and varies from an akinetic injection technique to a non-akinetic topical technique. Each technique has its own risk/benefit profile, and proven to be highly successful if performed correctly. The choice of the technique should be individualized based upon specific needs of the patient, the nature and extent of eye surgery, and the anaesthesiologist's and surgeon's preferences and skill. This review article attempts to outline the orbital anatomy, discuss the commonly used agents, current method of pre-operative preparation, available clinical techniques and their inherent complications.

Exudative Retinal Detachment Associated with Complicated Retrobulbar Anesthesia

“…The sharp needle causes vascular injury and bleeding, which results in progressive proptosis, elevated intraocular pressure (IOP), chemosis and swelling of the eyelids. Immediate IOP lowering therapy such as intravenous mannitol infusion and lateral canthotomy are generally needed to prevent permanent visual damage [1] [2]. To best of our knowledge, this is the first study to report a case with isolated exudative retinal detachment following retrobulbar hemorrhage as a complication of retrobulbar block.…”

“…On the operation day, the patient underwent retrobulbar anesthesia and three milliliters of local anesthetic agent was injected into the left retrobulbar space using Atkinson needle (25-gauge × 32 mm) at inferolateral orbital region as commonly described [1]. Immediately after the injection, dramatic proptosis, chemosis and eyelid edema were observed.…”

“…Injection of local anesthetic agents into retrobulbar space carries risks for many local and systemic complications such as subcon-junctival hemorrhage, chemosis, retrobulbar hemorrhage, extraocular muscle injury, globe perforation, optic neuropathy, retinal artery occlusion, seizures, transient blindness, cardiopulmonary collapse, III cranial nerve palsy and brainstem anesthesia [1]- [7].…”

“…Topical anesthesia is widely used for elective phaco surgery, whereas in complicated cases and posterior segment surgeries, surgeons prefer retrobulbar block, which provides a deeper anesthesia [1]. Injection of local anesthetic agents into retrobulbar space carries risks for many local and systemic complications such as subcon-junctival hemorrhage, chemosis, retrobulbar hemorrhage, extraocular muscle injury, globe perforation, optic neuropathy, retinal artery occlusion, seizures, transient blindness, cardiopulmonary collapse, III cranial nerve palsy and brainstem anesthesia [1]- [7].…”

Dexmedetomidine vs. Magnesium Sulphate as an Adjuvant to Rocuronium Bromide, and Local Anaesthetic Mixture in Peribulbar Anaesthesia for Viteroretinal Surgery

“…Vitreoretinal surgery is a surgery involving the vitreous and retina, they are lengthy procedures and associated with significant pain [1], it has traditionally been performed under general anesthesia but local anesthesia has increased in popularity in recent years [2].…”