Usefulness of intraoperative three-dimensional imaging in fracture surgery: a prospective study

BackgroundSince its introduction, intraoperative threedimensional (3D) imaging has enabled the analysis of articular fractures and implant positions during fracture surgery. The purpose of this study was to evaluate the usefulness of intraoperative 3D imaging in locating anatomic structures, correcting errors, and preventing revision surgery.MethodsBetween March 2010 and November 2012, intraoperative 3D imaging was used during surgery for 109 fractures in 101 patients. Fluoroscopy was performed with the Iso-C3D^™ (Siemens, Erlangen, Germany). We recorded the number of intraoperative revisions for adjustment of fracture reduction and correction of implant position for these fractures.ResultsCases comprised intra-articular fractures (55 %), disruptions of the posterior pelvic ring (33 %), and syndesmotic injury (12 %). The intraoperative revision rate was 9.2 % (10/109). When considered by fracture site, the revision rate was highest for syndesmotic injury (23.1 %), followed by iliosacral fixation (8.3 %) and intra-articular fractures (6.6 %). We changed the implant position in six cases, corrected the articular reduction in one case, and revised the malreduction of syndesmosis in three cases. No postoperative infection occurred in any of these cases. ConclusionsIntraoperative 3D imaging is useful for correcting errors and may prevent a second operation. Three-dimensional imaging may be especially helpful in intra-articular fractures, iliosacral screw fixation, and syndesmotic injury.     

Ropivacaine in peribulbar block: a comparative study with bupivacaine

BACKGROUND: Ropivacaine is a new local anesthetic with alleged lower systemic toxicity and slightly lower potency as compared with bupivacaine. The present study aimed to evaluate the efficacy of ropivacaine in peribulbar block, as compared with that of bupivacaine. METHODS: Eighty patients aged 45-92 years with physical status ASA I, II, or III were randomized to Group R (n=40) or Group B (n=40). Group R received 8.0 ml of 1.0% ropivacaine and Group B received 8.0 ml of 0.75% bupivacaine, both solutions with 50 IU/ml hyaluronidase, to induce peribulbar block according to the double-injection technique. Decreased ocular motility was the only criterion of successful block. RESULTS: The percentage of patients with decreased ocular motility showing successful block was higher in Group R 1 and 5 min after injection. A score indicating successful peribulbar block was found in all patients 10 min after injection. While no patient complained of a burning sensation during ropivacaine injection, 22.5% of the patients given bupivacaine reported this symptom. CONCLUSION: Both local anesthetics were effective in inducing peribulbar block for intraocular surgery. A tendency was noted to a faster onset of peribulbar block with ropivacaine; nevertheless, both drugs had a high degree of success for this block.     

Haemorrhage and risk factors associated with retrobulbar/peribulbar block: a prospective study in 1383 patients

Patients undergoing intraocular surgery are elderly and mayhave disease or be receiving medication which increases therisk of haemorrhage. We interviewed 1383 consecutive patientsscheduled for eye surgery requiring retrobulbar/peribulbar blockabout their use of non- steroidal anti-inflammatory drugs, oralsteroids and warfarin. A history of diabetes mellitus and globeaxial length was noted. Medial peribulbar and inferolateralretrobulbar blocks were performed by three specialists and sixdoctors in training. The ensuing haemorrhages were graded asfollows: 1=spot ecchymosis; 2=lid ecchymosis involving halfof the lid surface area or less; 3=lid ecchymosis all aroundthe eye, no increase in intraocular pressure; 4=retrobulbarhaemorrhage with increased intraocular pressure. Acetylsalicylicacid was taken by 482 (35%) patients, non-steroidal anti-inflammatorydrugs by 260 (19%) and warfarin by 76 (5.5%). Lid haemorrhages(grades 1–3) were observed in 55 patients (4.0%); in 33of these patients the haemorrhages were spotlike (grade 1).No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylicacid, non-steroidal anti-inflammatory drugs or warfarin, whetheror not they had been discontinued, did not predispose to haemorrhageassociated with retrobulbar/peribulbar block. Br J Anaesth 2000; 85: 708–11     

Preoperative peribulbar block in patients undergoing retinal detachment surgery under general anesthesia: a randomized double-blind study

Retinal detachment surgery is frequently associated with significant postoperative pain and emesis in adults. In this randomized, double-blind, controlled study we sought to demonstrate that 1% ropivacaine peribulbar (PB) block in conjunction with general anesthesia (GA) improves operative conditions and postoperative analgesia compared with GA combined with subcutaneous normal saline injection into the inferior eyelid. Thirty-one patients were included in each group. Anesthesia was performed with target-controlled infusion propofol and continuous remifentanil infusion adjusted to maintain bispectral index values between 40 and 50. Postoperative analgesia included fixed-dose IV infusion of propacetamol and IV injection of nefopam via a patient-controlled analgesia device. Tramadol was infused IV as rescue medication. Demographic data were comparable between the groups and bispectral index values were maintained at the objective target. In the PB group, fewer patients presented an oculocardiac reflex (6 versus 17; P < 0.01); bleeding interfering with the surgical field was reduced (1 versus 11 patients; P < 0.01); mean time to first nefopam request was longer (148 +/- 99 versus 46 +/- 58 min; P < 0.01); mean nefopam consumption was diminished during the first 6 h after tracheal extubation (18.9 +/- 13.9 versus 28.5 +/- 14.7 mg; P < 0.05); immediate postoperative pain scores were lower; and fewer patients required rescue medication (5 versus 23; P < 0.01). The two groups were similar with respect to the incidence of postoperative nausea and vomiting. Overall, PB block combined with GA improved operating conditions and postoperative analgesia in retinal detachment surgery.     

Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: Randomized controlled study

Background

The use of an adjuvant to local anesthetics in the peribulbar block may improve the block characteristics. This study aimed to evaluate the effect of the addition of either ketamine or fentanyl to local anesthetics in single injection peribulbar block on the quality of the block.

Patient-controlled sedation for cataract surgery using peribulbar block

Patients undergoing cataract surgery using peribulbar block were allocated randomly to self-administer doses of either midazolam 0.1 mg or propofol 3.3 mg without a lock-out facility; in the control group the syringe was charged with saline, not as a placebo, but to "blind" the surgeon and the nurse observer. For midazolam and propofol, median doses were 2.54 (0.1-6.0) mg and 87.4 (0-145) mg, respectively. Patient- controlled sedation significantly reduced the level of anxiety, with median visual analogue anxiety scores in the midazolam, propofol and saline groups of 5 (0-38) mm, 5 (0-25) mm and 15 (0-92) mm, respectively (P < 0.05). Some patients did not administer the sedative when available while others in the saline group would have benefited from anxiolytic drugs. While both drugs prevented an increase in heart rate, only midazolam prevented an increase in arterial pressure during surgery.      

Bradycardia and hypertension in anticipation of, and exacerbated by, peribulbar block: a prospective audit

BACKGROUND: Changes in heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) occur in anticipation of, and following, injection of a peribulbar local analgesic agent. We examined these changes in two groups of awake patients given a pre-medication of either hydroxyzine 1.0 mg/kg alone (control) or hydroxyzine 1.0 mg/kg with morphine 0.05 mg/kg. METHODS: HR, SAP and DAP of 100 patients per group were monitored the day before surgery (baseline), every 5 min in the anesthesia holding room before peribulbar injection, every minute for the first 5 min after peribulbar injection and then every 5 min until transfer to the operating room. Within and between pre-medication group values of HR, SAP and DAP before and after peribulbar injection were compared with baseline. RESULTS: The two groups of patients were similar. Before peribulbar injection, HR was unchanged in the hydroxyzine group, but 6% slower in those given morphine (P<0.01). After injection, HR slowed in both groups, by 5% and 7% (P<0.01, both comparisons), respectively. In anticipation of injection, SAP increased in both groups to 20% and 16% above baseline, respectively, and increased further after injection to 26% and 24% above baseline, respectively (P<0.001, all comparisons). In both groups, maximum SAP following injection exceeded maximum SAP before injection (P<0.02, both comparisons). DAP increased by 4% (P<0.05) in the hydroxyzine group before injection, and by 5% and 4%, respectively (P<0.005 and P<0.05, respectively) after peribulbar injection. CONCLUSION: The audit reveals pronounced increases in SAP accompanied by lesser increases in DAP and a tendency to slowing of HR in awake patients in anticipation of peribulbar injections. Peribulbar injections cause further increases in blood pressure and mild bradycardia. These changes occur similarly in patients pre-medicated with hydroxyzine or hydroxyzine plus morphine. A mix of neuro-humoral influences (anxiety/catecholamine/baroreceptor/trigemino-vagal) are postulated as etiological.     

Intraocular pressure and ropivacaine in peribulbar block: a comparative study with bupivacaine

BACKGROUND: The aim of this study was to compare the effects on intraocular pressure (IOP) of ropivacaine and bupivacaine in peribulbar block. METHODS: The study involved 40 patients with ASA physical status I, II or III undergoing cataract surgery under peribulbar block. Patients were allocated to two groups according to the local anesthetic used: Group R (n=20), 1.0% ropivacaine and Group B (n=20) 0.75% bupivacaine, both associated with 50 IU. ml-1 hyaluronidase, in peribulbar double injection technique. IOP was measured at four time points: 0=before block (control); 1=1 min after block; 2=5 min after block; 3=15 min after block. RESULTS: Mean values of IOP (mm Hg) after block were significantly lower in Group R in comparison to Group B: time point 1=13.4+/-3.2 vs 20.8+/-4.7; time point 2=10.9+/-3.7 vs 14.4+/-3.8; time point 3=7.7+/-4.0 vs 10.5+/-3.1. The variation of IOP was different in each group. In Group R, the mean values obtained at the three time points after block were significantly lower than the control; in Group B, the mean value of IOP rose significantly 1 min after block and was lower than control only at time point 3. CONCLUSIONS: Ropivacaine 1.0% associated with hyaluronidase in peribulbar block is better than 0.75% bupivacaine under the same standard conditions for lowering IOP in intraocular surgery. This effect is probably due to relaxation of the extraocular muscles after the block with both anesthetics, and possibly to a smaller intraocular blood volume due to vasoconstriction in the case of ropivacaine.     

The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery

The purpose of this study was to evaluate peri‐operative outcome after vitreoretinal surgery when peribulbar anaesthesia is combined with general anaesthesia. Sixty adult patients undergoing elective primary retinal detachment surgery with scleral buckling or an encircling procedure received either peribulbar anaesthesia in conjunction with general anaesthesia or general anaesthesia alone. For peribulbar anaesthesia a single percutaneous injection of 5–7 ml of local anaesthetic solution (0.75% ropivacaine with hyaluronidase 15 iu.ml^?1) was used. The incidence of intra‐operative oculocardiac reflex and surgical bleeding interfering with the surgical field, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In the block group there was a lower incidence of oculocardiac reflex and surgical bleeding intra‐operatively. Patients in the block group also had better postoperative analgesia and a lower incidence of postoperative nausea and vomiting compared with the group without a block. The use of peribulbar anaesthesia in conjunction with general anesthesia was superior to general anaesthesia alone for vitreoretinal surgery with scleral buckling.     

A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery

Background Context

Surgical procedures involving the spine are known to cause moderate to severe postoperative pain. Inadequate management of acute pain in the postoperative period results in higher morbidity, and consequently may lead to chronic pain caused by central sensitization. The role of pre-emptive analgesia (PA) and intraoperative analgesia in management of postoperative pain has gained precedence over recent years. Pathophysiology of postoperative pain in spine surgery is unique, as it is a combination of nociceptive, inflammatory, and neuronal stimuli. Blockage of all three stimuli in the perioperative period by pre-emptively administrating a combination of paracetamol (P), ketorolac (K), and pregabalin (PR) might help in adequate management and alleviation of acute postoperative pain.

Deep topical fornix nerve block versus peribulbar block in one-step adjustable-suture horizontal strabismus surgery

Background. We compared the efficacy of deep topical fornixnerve block anaesthesia (DTFNBA), which does not paralyse theextraocular muscles, with peribulbar block in patients undergoingone-step adjustable-suture horizontal strabismus surgery. Patientswith a vertical, oblique squint were excluded from the study. Methods. We studied 100 patients, allocated randomly to twogroups. Group 1 (n=50) received peribulbar block with 5 mlof 1:1 mixture of 0.5% plain bupivacaine and 2% lignocaine supplementedwith hyaluronidase 300 i.u. ml^–1. Group 2 (n=50)received DTFNBA with placement of a sponge soaked in 0.5% bupivacainedeep into the conjunctival fornices for 15 min. No sedationwas given to either group. Analgesia was assessed by directquestioning of patients during the procedure. A three-pointscoring system was used (no pain =0, discomfort =1, pain =2).If the pain score was 1, the patient was asked to look in theopposite direction to decrease the tension on the periostealattachment of the muscle to relieve discomfort. If the painscore was 2 at any stage of the operation, general anaesthesiawas given. Results. In Group 2, significantly more patients (15) experienceddiscomfort than in Group 1 (no patients) (P<0.05), but generalanaesthesia was not needed. Conclusions. DTFNBA is a useful technique for intraoperativeadjustable-suture strabismus surgery. It does not alter muscletone, thus allowing the surgeon to adjust the muscle suturesintraoperatively, and reducing the incidence of under- or over-correctionof the squint in the immediate postoperative period. Br J Anaesth 2002; 88: 129–32     

Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children

Background and aims  The aim of this study was to investigate fast-track concepts in routine pediatric surgery in a university clinic over 1 year. Patients/methods  Fast-track concepts were established for procedures requiring hospital admission in patients up to 15 years of age. Patients were studied prospectively from June 2006 to June 2007. Results  Out of a total of 436 potentially suitable patients, 155 (36%) were finally treated following the protocols. The mean intensity of pain in children younger than 4 years (CHIPPS, 0–10) was 1.3 ± 1.5 the evening of the operation day and decreased to <1 at all other time points. The initial postoperative mean pain intensity in older children (Smiley/VAS, 1–10) was 3.7 ± 2.2 and decreased constantly thereafter. The mean hospital stay of fast-track patients was significantly shorter compared with German diagnosis-related group data (4.6 ± 2.9 versus 9.7 ± 3.8, p < 0.01). There were four (3%) readmissions for minor complications. At follow-up after 2 weeks, 95% of patients and parents judged fast-track care as excellent. Conclusion  Fast-track concepts are feasible in one third of pediatric patients undergoing routine in-hospital surgery. Fast-track pediatric surgery achieves accelerated convalescence, minimal hospital stay, and high patient and parent satisfaction.     

Hemodynamic and respiratory effects of pediatric urological retroperitoneal laparoscopic surgery: a prospective study

PURPOSE: Our understanding of the effects of retroperitoneal CO(2) insufflation on cardiopulmonary variables in children remains limited. This study was designed to investigate prospectively the effect of CO(2) insufflation in a pediatric population undergoing retroperitoneal laparoscopic surgery. MATERIALS AND METHODS: We prospectively evaluated a consecutive series of patients enrolled between July 2003 and August 2004. Anesthesia was administered following a standardized protocol. Data collection included respiratory rate, PAP, O(2) saturation, ETCO(2), HR, MAP, electrocardiogram and insufflation pressure. All variables were recorded before, during and after CO(2) insufflation at regular intervals of 1 to 2 minutes, with up to 23 measurements recorded for each period. RESULTS: A total of 18 participants were recruited. Mean +/- SD for age and weight were 79.4 +/- 53.2 months and 26.7 +/- 15.5 kg, respectively. Mean retroperitoneal CO(2) insufflation pressure was kept at 12 mm Hg. Significant differences (p <0.05) in average ETCO(2), PAP and MAP were noted after CO(2) insufflation compared to baseline (pre-pneumoretroperitoneum) values. HR and temperature did not change. At completion of the laparoscopic intervention physiological variables exhibited a trend to return to baseline values. CONCLUSIONS: This prospective study documents significant changes in systemic hemodynamic variables that seem to be directly associated with the insufflation of CO(2) during pediatric retroperitoneal laparoscopic surgery. This ongoing evaluation confirms the effect of laparoscopic urological surgery and CO(2) insufflation on cardiopulmonary function in children.     

Usefulness of routine preoperative testing: a prospective single-observer study

STUDY OBJECTIVE: The purpose of this study is to determine whether routine preoperative testing has a usefulness not previously recognized in a small preliminary study to decide if such a hypothesis might be worthy of testing in a larger study. DESIGN: Single-observer, prospective, observational study. SETTING: Tertiary-care referral center in South India that performs 11 preoperative tests on each patient. PATIENTS: One hundred twenty-seven adult patients scheduled for elective neurosurgery. INTERVENTIONS: Patients were studied to determine whether outcome was influenced by laboratory tests, which were either indicated by health history elicited by a computerized rule-based questionnaire or unindicated by patient history. MEASUREMENT AND MAIN RESULTS: Of the 1395 tests performed preoperatively, 513 (36.8%) were indicated and 882 (63.3%) were unindicated. Of 513 indicated tests, 17 (3.3%) prompted changes in patient care; 8 (0.91%) of 882 unindicated tests (P < .001) prompted changes in care. All patients with anemia, significant electrocardiographic abnormalities, or HIV infection were detected by the computerized questionnaire. Among the changes in care prompted by unindicated tests, 4 patients received diabetic therapy or counseling, and 4 patients with abnormal silhouettes on chest radiograph had nonbeneficial echocardiography. Only screening for diabetes seemed to have usefulness as a routine preoperative test in this patient population. CONCLUSION: Although the incidence of unindicated preoperative screening tests is still more than 50%, no previously unidentified benefit was found to support this persistence of unwarranted testing. The limited number of patients in this study necessitates a larger study to ensure greater certainty before such a recommendation is made to the public. If similar results in another but larger study involving similar design, simple changes in the system of preoperative care may save the health care system the considerable expense of unwarranted testing.     

The Canadian pediatric surgery workforce: A 5-year prospective study

BackgroundIn 2014, a survey study of the Canadian pediatric surgery workforce predicted a need for 2 new pediatric surgeons/yr. in Canada. We sought to assess these predictions and evaluate the status of the workforce.MethodsWith IRB approval, a web-based survey was sent to pediatric surgery division chiefs in Canada each year (2013–2017). The survey data included: number of practicing pediatric surgeons, full time equivalent (FTE) positions, and fellowship graduates.ResultsThere was a 100% response rate (18 divisions). From 2013 to 2017, the number of practicing pediatric surgeons and FTE positions increased (73 to 78, and 64.6 to 67.5, respectively). Eleven positions were vacated (4 retirement, 7 new practice), and 18 were filled. Eight were filled by new Canadian graduates, 7 by Canadians previously working in Canada or abroad, and 3 by European surgeons. Thirty-eight fellows completed training in Canada, including 24 non-Canadians who all left Canada. Nine Canadians who started practicing immediately after fellowship took positions in Canada (5) and the US (4).ConclusionsPredictions made in 2014 were largely accurate. There has been modest growth in the Canadian pediatric surgery workforce over the last 5 years. A significant mismatch continues to exist between Canadian pediatric surgery graduates and attending staff positions.Type of studySurvey.Level of evidenceV     

Medial canthus single-injection peribulbar anesthesia: a prospective randomized comparison with classic double-injection peribulbar anesthesia

BACKGROUND AND OBJECTIVES: The authors report the first prospective randomized comparison of the medial canthus single-injection peribulbar anesthesia (also called caruncular anesthesia) with the classic double-injection peribulbar technique. METHODS: One hundred patients scheduled for cataract surgery were randomly assigned to either a single medial canthus injection or a double peribulbar injection of mepivacaine 2%. The amount of anesthetic agent injected was clinically adapted to each patient. Akinesia, volume injected, pain, reinjections, and complications were assessed after the procedure. RESULTS: The medial canthus single-injection peribulbar anesthesia was significantly less painful and required less anesthetic agent than the double-injection peribulbar anesthesia. Akinesia score and the reinjection rate were similar in the 2 groups, whereas chemosis was significantly more frequent in the double-injection group. CONCLUSIONS: Medial canthus single-injection peribulbar anesthesia appears to be an effective alternative to the usual double-injection peribulbar anesthesia.     

Supplementation of retrobulbar block with clonidine in vitreoretinal surgery: effect on postoperative pain

Study Objective

To evaluate the effect of clonidine when added to local anesthetics on duration of postoperative analgesia during retrobulbar block.

Design

Prospective, randomized controlled trial.

Setting

Operating room and Postanesthesia Care Unit of a university-affiliated hospital.

Subjects

80 ASA physical status 1, 2, and 3 patients undergoing vitreoretinal surgery with or without scleral buckling.

Interventions

Patients in the control group (n = 40) received a retrobulbar block with 4.5 mL of lidocaine-bupivacaine and 0.5 mL of saline. Clonidine group patients (n = 40) received 4.5 mL of lidocaine-bupivacaine and 0.5 μg/kg of clonidine in a 0.5 mL volume.

Measurements

The time to first analgesic request, frequency of postoperative pain, and number of postoperative analgesic requests per patient were assessed.

Main Results

37 patients in the control group (92.5%) versus 24 patients (60%) in the clonidine group reported pain postoperatively (P = 0.001), with a shorter time to first analgesic request noted in the control group (4.9 ± 3 vs 11.9 ± 5.3 hrs; P < 0.001). The median number of postoperative analgesic requests per patient during the first 24 hours was higher in the control group than the clonidine group [2 (0-3) vs. 1 (0-3); P < 0.001].

Conclusions

The addition of clonidine 0.5 μg/kg to the local anesthetics of a retrobulbar block for vitreoretinal surgery decreases the frequency of postoperative pain and prolongs the time of analgesia.     

Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial

Background: Ultrasound‐guided transversus abdominis plane (TAP) block has shown promise for analgesia after pediatric inguinal surgery. This prospective, randomized study tested the hypothesis that the TAP block would provide comparable analgesia after pediatric inguinal surgery compared with a conventional ultrasound‐guided ilioinguinal block. Methods: After induction of general anesthesia , infants and children presenting for elective inguinal surgery were randomly assigned to receive an ultrasound‐guided TAP block (needle cephalad of the iliac crest at the anterior axillary line) (n = 20) or ilioinguinal block (needle immediately anteromedial to the anterior superior iliac spine) (n = 21). Supplemental analgesia consisted of as‐required intraoperative fentanyl, regular acetaminophen, as‐required ibuprofen, and rescue morphine. Patients were assessed in the recovery room, the day‐stay unit (30 min to 2 h after surgery) and at 24 h for age appropriate numerical pain score, analgesic consumption, and parental satisfaction. Results: In the day‐stay unit, pain was more frequent (76% vs 45%, P = 0.040), and ibuprofen use was higher (62% vs 30%, P = 0.037) in the TAP group. Recovery room pain, morphine consumption and postdischarge ibuprofen use, comfort and satisfaction scores were similar between groups. Ultrasound image quality was poorer, and needle time under the skin was longer (median [interquartile range] 81 [66–120] vs 46 [40–51], P < 0.001) for the ilioinguinal group. Conclusions: Following pediatric inguinal surgery, ilioinguinal block provides more effective analgesia than the TAP block.     

Dexamethasone bupivacaine versus bupivacaine for peribulbar block in posterior segment eye surgery

AimThe study conducted aims to assess the efficacy, time to first analgesic request, and postoperative inflammatory response after adding dexamethasone to local anesthetic mixture for a peribulbar block in posterior segment eye surgery.Patients and methodsA double-blind randomized study was carried out on 50 ASA I and II patients scheduled for elective posterior segment surgery (vitreoretinal). Patients were allocated randomly into two groups, 25 patients in each group. Group I received equal volumes of 10 ml of a l:1 mixture of bupivacaine 0.5% and saline, supplemented with 4 mg dexamethasone in 1 ml saline and group II received the same local anesthetic mixture (total volume 10 ml) without adding dexamethasone. The duration and onset of motor block, time to first analgesic request, postoperative inflammatory response, and other side effects such as nausea and vomiting were assessed.ResultsPatients receiving peribulbar block were significantly pain free by end of surgery (0 h) (P < 0.05) and throughout the postoperative period in the dexamethasone group at 2 and 6 h postoperatively. The number of patients requiring rescue analgesics was significantly lower with dexamethasone bupivacaine block (P < 0.05). The incidence of postoperative nausea and vomiting was significantly less in the first group (I) in comparison to the other group (II) (P < 0.05) and lastly the level of C reactive protein postoperatively was found to be significantly less in the dexamethasone group than the other one (P < 0.0001).ConclusionAdding dexamethasone to bupivacaine in peribulbar block appears to be a safe and clinically superior adjuvant with less postoperative pain, inflammatory response in patients undergoing posterior segment eye surgery.