Generalized Seizures During Cataract Surgery Following Peribulbar Block: A Case Report

Abstract

Local anesthesia techniques are commonly used to perform the cataract surgery. Among these techniques, peribulbar anesthesia (PBA), when compared to retrobulbar anesthesia, is more effective and safe. However, PBA is not without risk. Complications may arise which if not recognized early and resuscitated, can be fatal. A 70-year-old Indian female was admitted for cataract extraction and lens implant in her left eye. Lignocaine sensitivity was done and showed no abnormal reaction. She developed generalized tonicclonic convulsions following peribulbar block. This case report attempts to highlight the need for a trained personnel, compliance with safety standards in anesthesia, awareness, and early recognition of the possible complications and their management.

Brainstem anesthesia: A rare complication after peribulbar anesthesia

“…In this respect, our case was similar to that of Bensghir et al [8]. Paul et al [9] reported a case of BSA after the peribulbar block where the presentation was convulsion similar to ours, without respiratory arrest followed by prolonged hypotension requiring vasopressor agents.…”

“…BSA is a rare but serious complication of the peribulbar block. To the best of our knowledge, fewer than ten cases have been reported in the literature [4][5][6][7][8][9][10].…”

“…The rate of major complications after peribulbar anesthesia was reported to be 0.006% in patients undergoing ophthalmic surgery [2,3]. Although the peribulbar block is theoretically considered to be much safer and easier to apply, some cases of brainstem anesthesia (BSA) after peribulbar block have been reported in the literature [4][5][6][7][8][9][10]. Herein, we report a case of respiratory depression and convulsion caused by probable BSA due to peribulbar block that was administered before cataract surgery.…”

Neuro-Ophthalmological Emergencies. Are They Always Innocent? A Case Report and a Literature Review

“…Several mechanisms may lead to CNS spread of local anesthetics during peribulbar anesthesia. Clinical signs typically have a rapid onset and can range from loss of consciousness to cardiac arrest [22]. Firstly, an inadvertent intra-arterial injection in the ophthalmic artery or into one of its branches can occur.…”

“…Convulsions following peribulbar block could be attributed to the oculocardiac reflex, hypoglycemia, hypoxia, or pro-stroke toxicity of local anesthetics [7,22,26]. Although the mechanisms of seizures are not known, it is speculated that there is a selective blockage of inhibitory synapses.…”