Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases

Abstract

Aims-A prospective study was carried out in order to evaluate the eYcacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions. Methods-Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9-22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied. Results-Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an "open sky" situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. Conclusion-These results demonstrate that peribulbar anaesthesia oVers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery. (Br J Ophthalmol 1999;83:104-109)

Hyaluronidase Increases Electrogene Transfer Efficiency in Skeletal Muscle

“…Hyaluronidase is a medical preparation of highly purified bovine testicular enzyme. It is used for clinical applications related to the facilitation of hypodermoclysis, the subcutaneous administration of fluids that allow hydration of tissues without the accumulation of edema (Berger, 1984); to the reabsorption of edemas (Johnsson et al, 1999); and to the formulation of local anesthetics (Lewis-Smith, 1986), particularly for the peribulbar region (Muraine et al, 1999). Thus, it is not surprising that histological analysis did not reveal significant or permanent alterations of the injected tissues (Fig.…”

Peribulbar anesthesia and sub‐Tenon injection for vitreoretinal surgery: 300 cases

“…The injection was immediately stopped when the globe became tense. The tension was appreciated subjectively in this study, we know it can reach a mean value of 33.69 mmHg (Muraine et al 1999). As soon as the globe became soft, injection was started again until another sensation of tension of the globe.…”

“…Peribulbar was performed according to the Hamilton technique (Hamilton 1995) and as described in our previous study (Muraine et al 1999). The first percutaneous insertion of the needle (25 gauge, 35 mm long) was parallel to the orbital floor at the lateral aspect of the inferior orbital rim (25 mm in maximal depth), and the second percutaneous (25 mm in maximal depth, too) at level of supraorbital notch.…”

Are ocular injection anesthetic blocks obsolete? Indications and guidelines

“…Also, many protocols for peribulbar anesthesia specify very large volumes of local anesthetic for good akinesia, up to 18 ml, followed by much as 20 0 of ocular compression The articles were reviewed and collated with respect to the country of origin and the type of surgery for which peribulbar was administered. [55,56]. Such large volumes may increase the risk of brainstem anesthesia and toxic reactions particularly when used in conjunction with additional anesthetic to block the orbicularis.…”