Persistent diplopia after retrobulbar anesthesia

Han, Soo Kyung; Kim, Jeong Hun; Hwang, Jeong‐Min

doi:10.1016/j.jcrs.2005.03.041

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…In previous reports, topical anaesthesia was proposed for limbal SOR to reduce surgery time and obviate potential risks associated with retrobulbar injection including globe perforation or postoperative diplopia (Cacciatori et al. 2007a; Han et al. 2004; Qin et al.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

Ivastinović

Saliba

Ardjomand

et al. 2011

Acta Ophthalmologica

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ABSTRACT.Purpose: To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium. Methods: Sixteen aphakic patients with silicone oil endotamponade requiring SOR were recruited for this prospective study and randomly scheduled for limbal or pars plana SOR. The central corneal thickness (CCT), visual acuity (VA) and intraocular pressure were measured preoperatively, on the first postoperative day and 4 months after surgery. Endothelial cell density (ECD) was measured preoperatively and at the end of follow-up. The in vitro study was performed on ten enucleated porcine eyes. Corneoscleral discs were prepared and fixed on artificial anterior chamber followed by 2.5-mm limbal incision and 5-ml silicone oil injection in six cases and 5 ml balanced salt solution (BSS) in four cases. Results: The ECD decreased by 239.2 ± 86.7 (13.9%) and 86.7 ± 22.4 cells ⁄ mm 2 (5%) after limbal (n = 8) and pars plana SOR (n = 8), respectively (p < 0.001 for both). The difference between the groups was significant (p < 0.001). A significant increase in CCT and corresponding decrease in VA was noted on the first postoperative day using both procedures. At the end of follow-up, the CCT and VA were comparable to initial values. Postoperative hypotony (£6 mmHg) was observed more frequently after limbal SOR. In the experiment, lamellar abrasions of corneal endothelium were observed after silicone oil injection, whereas no changes were observed after BSS injection. Conclusion: Limbal SOR causes more considerable damage to the corneal endothelium than the pars plana approach because of mechanical abrasion.

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Section: Discussionmentioning

confidence: 99%

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

Ivastinović

Saliba

Ardjomand

et al. 2011

Acta Ophthalmologica

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“…192 4,5,89e106 NS, 5,90,93,95e98,101,102,104e106, 23G, 100 24G, 92,103 25G, 4,89,91,94,100 26G 92 27G 100NS, 102 bupivacaine, 90,92,99,104 bupivacaineþ lidocaine, 4,89e93,95,97,98,100,101,105 bupivacaineþmepivacaine, 4 lidocaine, 4,5,94,96,103,104,106 mepivacaine 90 Peribulbar LA 4,89,91,92,95,100,101,105,107e113 CS y , 89,91,92,95,101,105,107e109,111,113 PC, 112 RC y4,100,110…”

Section: Future Research Directionsmentioning

confidence: 99%

“…None 86 0.25% 86 6 mL 86 Depression of super aspect of scapula; tenderness; no signs of inflammation 86 Complete in one out of one 86 2 months to complete 86 2% 88 4 mL 88 Peri-orbital haematoma, 88 diplopia, 88 hypotropia, 88 restriction of eye, 88 movement 88 No/partial in one out of one 88 6 months to no/ partial 88 NS, 5,102,105 none, 4,89,90,92,96,99,101 epinephrine, 93e95, 97,98,100,103,106 hyaluronidase 91,93e95,97,98,104 NS, 90,93,98,102 0.5%, 4,95 0.75%, 89,91,92,97,99e101,104,105 1%, 101 2%, 4,5,89,91,92,94e97,100,103,105,106 4%, 5,100,105 2e4% 104 NS, 5,90,93,95,96,99,102,106 1.5 ml, 97 3 ml, 89 4 ml, 92,…”

Section: Future Research Directionsmentioning

confidence: 99%

“…3 Although thought to be a rare and subclinical adverse effect of LAs in humans, several cases of clinically important myotoxicity have been reported in the literature, mostly after retrobulbar blocks. 4,5 Non-ophthalmic instances of myotoxicity in humans have previously been limited to a handful of case reports after interscalene nerve block 6 and trigger point injection. However, we now have a reason to believe that the adductor canal block model may also place patients at risk of what we suspect is LAinduced myotoxicity.…”

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confidence: 99%

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Local anaesthetic-induced myotoxicity in regional anaesthesia: a systematic review and empirical analysis

Hussain

McCartney

Neal

et al. 2018

British Journal of Anaesthesia

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Recent reports of local-anaesthetic (LA)-induced myotoxicity after peripheral nerve blocks have increased the interest in this less commonly known complication. Basic science evidence investigating LA-induced myotoxicity seems to demonstrate a pattern, but findings from human studies vary. This systematic review summarises the existing myotoxicity evidence and empirically examines its implications. Databases were searched for all in vitro animal and human studies evaluating LA-induced myotoxicity. Studies were stratified by design. Data sought included the model examined, LA used, injury mechanisms, nature of damage, and extent of recovery. For human studies, we also aimed to estimate prevalence and recovery rates. One hundred and fifteen studies, mainly animal and ophthalmic, were included. Myotoxicity risk factors included higher concentrations and prolonged exposure to LA, and use of bupivacaine. Injury mechanisms involved early and late aberrations to cytoplasmic calcium (Ca) homeostasis by the sarcoplasmic reticulum Ca ATPase. Incidence in ophthalmic studies was 0.77% (392 of 50 618). Inflammatory changes within a few days after exposure marked the onset of myotoxicity, and myo-degeneration followed within the first week post-exposure. Time to recovery in human muscles ranged between 4 days to 1 yr. None/partial and complete recovery were observed in 61% and 38% of patients, respectively. Across all experimental models, skeletal muscles exposed to LA consistently display myotoxic effects. Evidence is robust in animal and ophthalmic studies, and displays a concerning signal with continuous adductor canal block use in human case reports. Exploring the clinical prevalence, severity, and risk-reducing strategies of myotoxicity should be prioritised.

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“…Although usually safe, retrobulbar anesthesia has potentially sight‐ and life‐threatening complications. Complications are widely reported in humans and include globe perforation, retrobulbar and retinal hemorrhage, retinal ischemia, retinal detachment, diplopia, amaurosis, dysarthria, shivering, nausea, vomiting, respiratory arrest, paresis, convulsions, and coma 2–5,10–25 . The central nervous system (CNS) signs that occur following retrobulbar anesthesia are thought to arise from inadvertent injury of the optic nerve sheath and subarachnoid administration of local anesthetic with subsequent brainstem anesthesia 25–27 .…”

Section: Introductionmentioning

confidence: 99%

Suspected brainstem anesthesia following retrobulbar block in a cat

Oliver¹,

Bradbrook²

2012

Veterinary Ophthalmology

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A 10-year-old, male, neutered, domestic shorthair cat was anesthetised for enucleation of a perforated left globe. A retrobulbar injection of local anesthetic (lidocaine/bupivacaine) was performed prior to surgery to provide intra- and postoperative analgesia. Following administration of the injection, the cat developed apnea and heart rate increased. Mechanical ventilation was initiated and surgery went ahead as planned. At the conclusion of surgery, the cat remained apnoeic requiring positive pressure ventilation until spontaneous ventilatory effort resumed. Upon recovery, the cat demonstrated neurological signs including tremors, nystagmus and absent dazzle reflex. These signs were attributed to brainstem anesthesia from the retrobulbar block and fully resolved within 3 h. This is the first report of suspected intrathecal spread of local anesthetic following retrobulbar block in a cat to the authors' knowledge.

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Persistent diplopia after retrobulbar anesthesia

Cited by 3 publications

References 14 publications

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

Local anaesthetic-induced myotoxicity in regional anaesthesia: a systematic review and empirical analysis

Suspected brainstem anesthesia following retrobulbar block in a cat

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