Bran Stem Anesthesia after Retrobulbar Block

Javitt, Jonathan C.; Addiego, Rafael; Friedberg, Howard L.; Libonati, Margaret; Leahy, John J.

doi:10.1016/s0161-6420(87)33389-5

Cited by 149 publications

(49 citation statements)

References 18 publications

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“…Although conventional retrobulbar blocks provide effective local anesthesia, this blind administration of anesthetic has been associated with severe complications, including inadvertent globe penetration, optic nerve injury, injection into the subarachnoid space, brainstem anesthesia, retrobulbar hemorrhage, retinal vascular occlusion, seizures and cardiopulmonary arrest [15,16,17,18,19,20,21]. In order to reduce these risks, peribulbar blocks have been performed, but are associated with possible risks of globe penetration, longer akinesia times and side effects due to the injection of a large quantity of anesthetics, as well as taking a longer time than the retrobulbar block [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Effect of Volume Used in Sub-Tenon’s Anesthesia on Efficacy and Intraocular Pressure in Vitreoretinal Surgery

Sohn¹,

Moon²,

Nam³

et al. 2008

Ophthalmologica

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Purpose: To compare the effect of volumes used in sub- Tenon’s anesthesia on efficacy and intraocular pressure (IOP) in vitreoretinal surgery. Methods: A prospective clinical trial was conducted on patients undergoing sub-Tenon’s anesthesia for vitreoretinal surgery. Patients were randomized to receive either 3-, 5- or 7-ml volumes of anesthetic solution. IOP were measured immediately prior to injection, immediately after injection and at 2, 5 and 10 min after injection. Pain scores were assigned using a numerical visual analogue scale immediately after surgery, and again on postoperative day 1. Results: A total of 108 patients (119 eyes) were studied, including 35 eyes in the 3-ml group, 48 eyes in the 5-ml group, and 36 eyes in the 7-ml group. There were significant elevations in mean IOP following injection in all groups, and a trend for larger rises in IOP with larger volumes of anesthesia (p < 0.01). Mean IOP were elevated after injection, and reduced at all time intervals. However, the reduction in the 3-ml group took levels to preinjection amounts. There were no significant differences in patient-reported pain scores among the groups when assessed immediately after surgery or on postoperative day 1. The incidence of chemosis and high IOP elevations (≥40 mm Hg) were more frequent in the 7-ml group (p < 0.05). Conclusions: Sub-Tenon’s anesthesia is effective in vitreoretinal surgery. It would appear that a 3–5-ml volume of anesthetic is safe, when considering the associated complications.

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Section: Discussionmentioning

confidence: 99%

Effect of Volume Used in Sub-Tenon’s Anesthesia on Efficacy and Intraocular Pressure in Vitreoretinal Surgery

Sohn¹,

Moon²,

Nam³

et al. 2008

Ophthalmologica

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“…However, retrobulbar anaesthesia administration is an invasive procedure with possible vision threatening and systemic complications. 8,11,[20][21][22][23][24][25][26][27][28][29][30][31] Peribulbar anaesthesia is as effective as retrobulbar anaesthesia and appears to lead to fewer sight-and life-threatening complications. 9,11,32,33 Subtenon anaesthesia is another alternative with fewer risks, 10 but it is still an invasive treatment in patients.…”

Section: Discussionmentioning

confidence: 99%

Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial

Hsu

et al. 2005

Eye

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“…Peribulbar or retrobulbar anaesthesia, while providing excellent analgesia and akinesia, have been associated with rare1 but numerous ocular complications including diplopia,2 orbital haemorrhage,3 globe perforation,4 central retinal vein or artery occlusion,5 brainstem anaesthesia,6 7 optic nerve trauma,8 and ptosis 9. In addition, preoperative intravenous sedation is often required because patients find the injection painful and frightening.…”

mentioning

confidence: 99%

Sub-Tenon's anaesthesia: an efficient and safe technique

Roman

Sit

Boureau

et al. 1997

British Journal of Ophthalmology

121

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Aim-To evaluate sub-Tenon' s anaesthesia as an alternative to peribulbar anaesthesia. Methods-109 consecutive patients listed for various eye operations (including cataract, trabeculectomy, and vitrectomy) under peribulbar anaesthesia were operated on under sub-Tenon's anaesthesia instead. After topical anaesthesia a buttonhole was fashioned through the conjunctiva and Tenon's capsule 10 mm posterior to the limbus. 1.5 ml of lignocaine 2% was then delivered to the posterior sub-Tenon's space using a blunt cannula. The surgical procedure was performed immediately after the completion of the anaesthetic procedure. Chemosis, conjunctival haemorrhage, degree of akinesia, and pain scoring were analysed. Results-There were no anaesthesia related complications. The administration of the block was painless for 99.1% of the patients. In all, 97.3% reported no pain during surgery. There was no akinesia when assessed just after the completion of the block and akinesia was limited when assessed after surgery. Chemosis and conjunctival haemorrhage were frequent but caused no intraoperative problems. Conclusion-Sub-Tenon's anaesthesia is an eYcient and safe anaesthetic technique. It is a good alternative to peribulbar anaesthesia. (Br J Ophthalmol 1997;81:673-676) In addition, preoperative intravenous sedation is often required because patients find the injection painful and frightening. Recently there had been renewed interest in subTenon's anaesthesia. 10-12It is not a new technique since it was described as early as 1884 by Turnbull. 13 This prospective study reports our experience of sub-Tenon's anaesthesia using a blunt cannula for various anterior and posterior segment eye operations. Materials and methodsFrom February1996 to July 1996, 109 consecutive patients (47 males, 62 females with a mean age of 66) scheduled for peribulbar anaesthesia underwent surgery under subTenon's anaesthesia instead. Seventy six had phacoemulsification cataract extraction (temporal corneal or scleral tunnel incision), five underwent combined phacoemulsification with trabeculectomy, three pterygium removal, five trabeculectomy, six had a three port pars plana vitrectomy for dislocated fragments of lens in the vitreous following cataract surgery, three a pars plana vitrectomy for vitreous haemorrhage, three had silicone oil removal, one radial keratotomy, one secondary lens implantation, one artificial lens removal for chronic endophthalmitis, two hyphaema evacuation, and three necessitated surgical treatment of iris prolapse following cataract surgery.Duration of surgery, site of sub-Tenon's anaesthesia, conjunctival chemosis (0 = no chemosis; + = chemosis involving one quadrant; ++ = chemosis involving two quadrants; +++ = chemosis involving three or four quadrants), subconjunctival haemorrhage (0 = no haemorrhage; + = haemorrhage involving one quadrant; ++ = haemorrhage involving two quadrants; +++ = haemorrhage involving three or four quadrants) were all noted on a chart. Patients were asked to score the pain during the anaest...

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Bran Stem Anesthesia after Retrobulbar Block

Cited by 149 publications

References 18 publications

Effect of Volume Used in Sub-Tenon’s Anesthesia on Efficacy and Intraocular Pressure in Vitreoretinal Surgery

Effect of Volume Used in Sub-Tenon’s Anesthesia on Efficacy and Intraocular Pressure in Vitreoretinal Surgery

Interventions for relieving pain associated with panretinal photocoagulation: a prospective randomized trial

Sub-Tenon's anaesthesia: an efficient and safe technique

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