Regional anaesthesia for 12,000 cataract extraction and intraocular lens implantation procedures

The Cataract National Dataset Electronic Multi-centre Audit of 55 567 operations: anaesthetic techniques and complications

“…[4][5][6] The use of sedation with local anaesthesia (LA) has fallen from 6% in 1996 5 to 3.9% in 2003. 4,6 Day case ophthalmic surgery under LA has been shown to be safe [7][8][9] and is associated with the least disruption to the patient's normal daily activity. 9, 10 The choice of anaesthesia depends on a number of factors, including patient psychology, the particular features of the globe and the orbit, the anticipated surgical difficulty and the experience of the operating surgeon.…”

Regional anaesthesia for intraocular surgery

“…38 Hamilton et al reported brainstem anaesthesia in eight patients (0.15%) and five (0.1%) moderate retrobulbar haemorrhages in 5235 retrobulbar blocks, and none in 5704 peribulbar blocks. 19 On the other hand, computed tomography after peribulbar injection into ca-daver orbits revealed intraconal and intracranial spread of radiopaque dye which was seen tracking along the optic nerve sheath in one case. 187 Respiratory arrest soon after peribulbar injections has occurred in experienced hands, s l…”

“…19,23,39,40,[42][43][44]63,64,[69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84] Lidocaine has good penetrating properties and produces a fast onset, while bupivacaine provides the prolonged duration for surgery and for postoperative analgesia. In randomized, double-blinded studies, this combination has been demonstrated to produce a faster onset and longer duration of action than bupivacaine alone 85 or in combination with etidocaine.…”

“…~4 Hamilton et al reported five (0.14%) moderate retrobulbar haemorrhages in 3595 retrobulbar blocks. 19 Cionni and Osher collected 60 cases over a three-year, ten-month period, which represented an incidence of retrobulbar haemorrhage associated with retrobulbar blocks in their institution of 1.7%. ~o3 Retrobulbar haemorrhage has also been reported following posterior peribulbar block.…”

“…Meyers, with no supporting data, stated that the most common complication of retrobulbar block is the oculocardiac reflex, 182 while most authors do not list this as a complication. 19,183 The few authors who mentioned oculocardiac reflex as a complication of retrobulbar blocks quoted the paper by Berler. 180 In this paper, the reflex was induced by the block itself in one case, and was also evoked by pressure on the globe before or immediately after the block.…”