Vision loss and partial third nerve palsy following contralateral peribulbar anesthesia

Krilis, Matthew; Zeldovich, Alina; Garrick, R.; Goldberg, Ivan

doi:10.1016/j.jcrs.2012.10.019

Cited by 13 publications

(11 citation statements)

References 4 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This likely was because the nasociliary branch of the ophthalmic nerve, which innervates the cornea, passes in close proximity to the surface of the optic nerve. 33,44 Complications of needle-based regional ocular anesthesia may be local (eg, conjunctival edema or hemorrhage, globe perforation, and optic nerve or extraocular muscle damage) [51][52][53][54][55][56][57] or systemic (eg, oculocardiac reflex, local anesthetic toxicosis, intravascular injection, or intrathecal injection, which can induce seizures and cardiorespiratory arrest). 27,[57][58][59][60] Theoretically, RBA carries a higher risk of serious complications because of intraconal introduction of the needle.…”

Section: Discussionmentioning

confidence: 99%

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Shilo‐Benjamini

Pascoe

Maggs

et al. 2014

ajvr

View full text Add to dashboard Cite

Objective-To compare effectiveness and complications associated with peribulbar and retrobulbar anesthesia with bupivacaine in cats. Animals-6 healthy adult cats. Procedures-Cats were sedated with dexmedetomidine and received a peribulbar injection of 0.5% bupivacaine (1.5 mL), iopamidol (0.5 mL), and saline (0.9% NaCl) solution (1 mL) or retrobulbar injection of 0.5% bupivacaine (0.75 mL) and iopamidol (0.25 mL) in a crossover study with ≥ 2 weeks between treatments. The contralateral eye was the control. Injectate distribution was evaluated with CT. After atipamezole administration, periocular and corneal sensations, intraocular pressure (IOP), and ocular reflexes and appearance were evaluated for 24 hours. Results-All peribulbar and 3 of 6 retrobulbar injections resulted in CT evidence of intraconal injectate. Corneal sensation and periocular skin sensation were absent or significantly reduced relative to that for control eyes for 3 hours after peribulbar injection. Mean ± SD IOP immediately after injection was significantly higher for eyes with peribulbar injections (33 ± 12 mm Hg) than for control eyes or eyes with retrobulbar injections (both 14 ± 4 mm Hg) but 10 minutes later decreased to 18 ± 3 mm Hg. Exophthalmos, chemosis, and ptosis were evident in most injected eyes, and irritation was evident in 3 of 6 peribulbar-injected and 1 of 6 retrobulbar-injected eyes. All conditions resolved within 14 hours. Conclusions and Clinical Relevance-Peribulbar injection resulted in intraconal deposition of bupivicaine in a higher percentage of cats than did retrobulbar injection and induced notable anesthesia relative to that for the control eye; however, IOP increased temporarily.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Shilo‐Benjamini

Pascoe

Maggs

et al. 2014

ajvr

View full text Add to dashboard Cite

show abstract

“…Perioperative haemodynamic fluctuations constitute a subsequent risk factor of destabilization of atherosclerotic plaques that may result in lifethreatening cardiac and cerebrovascular events [10]. Central retinal vein occlusion [43], brainstem anaesthesia [44], transient complete visual loss and a partial third nerve palsy [45], pulmonary oedema [46], ocular explosion [47] and generalized tonic-clonic seizures [48] have been reported following PBB due to LA toxicity.…”

Section: Preventive Regional Analgesiamentioning

confidence: 99%

Effect of topical or peribulbar analgesia on the incidence of oculocardiac reflex, postoperative pain and postoperative nausea and vomiting following vitreoretinal surgery under surgical pleth index-guided general anaesthesia.

Stasiowski

Pluta

Lyssek-Boroń³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Despite of the risk of postoperative intolerable pain perception (PIPP), vitreoretinal surgery (VRS) requires general anaesthesia (GA) in selected patients. Intraoperative use of opioid analgesics (OA) during GA carries the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI) optimises the intraoperative titration of OA. Regional anaesthesia techniques are combined with GA to minimize the intraoperative use of OA. We evaluated the benefit of preventive analgesia techniques combined with GA using SPI-guided fentanyl (FNT) administration on the incidence of PONV, oculocardiac reflex (OCR) and PIPP in patients undergoing VRS. Methods: One hundred and five patients undergoing VRS were randomly allocated to receive either GA with SPI-guided fentanyl (FNT) administration alone (GA group) or with preventive topical 2% proparacaine (topical anaesthesia (TA) group) or preoperative peribulbar block (PBB) using 0.5% bupivacaine with 2% lidocaine (PBB group). Fifteen patients were excluded due to problems with postoperative SPI measurement. Results: Preventive PBB resulted in intraoperative reduction in FNT requirement, with no influence on perioperative outcomes. Intraoperative SPI-guided FNT administration during GA resulted in OCR in 7.78%, PONV in 10% and PIPP in 13.5% of patients undergoing VRS. Intraoperative SPI-guided FNT administration blunted the perioperative effect of preventive PBB and TA in terms of the presence of PONV, OCR and PIPP.Conclusions: The utility of SPI-guided FNT administration during GA eliminated benefits of preventive analgesia with PBB and TA following VRS. We recommend using intraoperative SPI-guided FNT administration during GA to reduce the presence of OCR, PONV and PIPP following VRS. Trial registration: The trial was approved and registered by The Ethical Committee of Medical University of Silesia on 29th of September 2015, as well as the project was registered in the Clinical Trial Registry (SilesianMUKOAiIT2, NCT02973581)Key words: vitreoretineal surgery, general anaesthesia, peribulbar block, topical anaesthesia, surgical pleth index.

show abstract

“…Although peribulbar anaesthesia is considered to be a safer alternative to retrobulbar anaesthesia for cataract surgery, transient or serious complications have been reported in the literature such as amaurosis and contralateral cranial nerve III (ptosis, and medium-sized pupils unresponsive to light stimulus) and VI nerve paralysis after peribulbar block which recovered completely after four hours [46] , Purtscher-like retinopathy (ischemic retinal whitening in a peripapillary pattern) [47] , central retinal artery occlusion [48][49][50] , transient complete visual loss and a partial third nerve palsy in the contralateral eye (probably due to trans optic nerve sheath spread of injected anaesthetic drug) [51] . Periocular necrotizing fasciitis after local retrobulbar anesthesia injection and facial block for cataract surgery in the left eye and canthotomy/cantholysis for treatment of moderate retrobulbar hemorrhage in the same eye was reported by Gelaw and Abateneh [52] .…”

Section: Complicationsmentioning

confidence: 99%

Local Anaesthesia in Cataract Surgery

Reddy

Thevi

2017

International Journal of Ophthalmic Research

View full text Add to dashboard Cite

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

show abstract

Vision loss and partial third nerve palsy following contralateral peribulbar anesthesia

Cited by 13 publications

References 4 publications

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Effect of topical or peribulbar analgesia on the incidence of oculocardiac reflex, postoperative pain and postoperative nausea and vomiting following vitreoretinal surgery under surgical pleth index-guided general anaesthesia.

Local Anaesthesia in Cataract Surgery

Contact Info

Product

Resources

About