Risks and sequelae of scleral perforation during peribulbar or retrobulbar anesthesia

Schrader, Wolfgang; Schargus, Marc; Schneider, Evelin; Josifova, Tatjana

doi:10.1016/j.jcrs.2009.12.029

Cited by 45 publications

(41 citation statements)

References 17 publications

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“…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

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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.

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Section: Discussionmentioning

confidence: 99%

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Shilo‐Benjamini

Pascoe

Maggs

et al. 2014

ajvr

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“…Patients with myopic globes, thin sclera and staphyloma, pose a higher risk of hemorrhage and globe perforation during insertion of a sharp needle. [12] STB is a safer alternative technique that not only avoid to penetrate a more vascular peribulbar area but also uses a blunt cannula instead of a sharp needle to avoid this complication. Different types of cannulas are currently used for STB, but ST cannula is considered the gold standard.…”

Section: Discussionmentioning

confidence: 99%

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

Al-Motowa

Ahmad

Khandekar

et al. 2016

Middle East Afr J Ophthalmol

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PURPOSE:To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery.METHODS:This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant.RESULTS:There were sixty patients in each group. The age between groups was not statistically different (P = 0.4). The body mass index was higher in the ST group compared to the OT group (P < 0.001). The akinesia score at 5 and 10 min did not differ between groups (P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups (P = 0.1 and P = 0.06, respectively). There were six patients with mild chemosis and redness in the OT group and 15 patients in the ST group.CONCLUSION:An OT cannula is equally effective as the conventional Steven's cannula for delivering STB anesthesia before cataract surgery.

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“…Complications such as retrobulbar hemorrhage, brain stem anesthesia and globe perforation have been widely reported [1]- [5] for all forms of practiced anesthetic techniques including peribulbar [3] and sub-Tenon's technique [5]. Fig.…”

Section: Introductionmentioning

confidence: 99%

An efficient capacitive sensing scheme for an ophthalmic regional anesthesia training system

Mukherjee

George

Sivaprakasam

2013

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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Ophthalmic regional blocks are critical preoperative procedures involving the insertion of a syringe needle into the orbital cavity at such a position and angle that akinesia and analgesia is achieved without damage or harm to the eye and its associated musculature. A training system that accurately represents the orbital anatomical features and provides qualitative feedback on the performed anesthetic technique, can be of immense help in reducing risks involved in regional block administration. In this paper, a training system that employs a special but simple capacitive sensing scheme has been developed. A rapid prototyped eye-model has been used to ensure anatomical accuracy. Capacitive transmitter electrodes placed on the orbital wall along the length of the extraocular muscles are excited with a special excitation sequence and the displacement current at the needle of the syringe is measured using simple electronic unit and a Data Acquisition System, enabling the developed Virtual Instrument to detect the depth of penetration and proximity of the syringe needle to the ocular muscles. Additionally, the system detects needle touch of the muscles accurately. The proposed electrode array system and excitation schemes have been validated on a prototype system thus demonstrating its usefulness for practical training purposes.

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Risks and sequelae of scleral perforation during peribulbar or retrobulbar anesthesia

Cited by 45 publications

References 17 publications

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

An efficient capacitive sensing scheme for an ophthalmic regional anesthesia training system

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