Posterior peribulbar anesthesia: an alternative to retrobulbar anesthesia

Posterior peribulbar anesthesia is a safe alternative to retrobulbar anesthesia for ophthalmic surgery. Because the anesthetic is deposited outside the muscle cone, the potential for intraocular or intradural injection is greatly minimized. Furthermore, intraconal hemorrhage and direct optic nerve injury is avoided. We illustrate the details of our technique for posterior peribulbar anesthesia and describe our experience in over 1,600 cases.     

Congenital corneal anesthesia related to trigeminal anesthesia: case report

Corneal anesthesia is a rare condition, therefore its diagnosis is frequently impaired or it is not noticed during the anterior segment examination. Case report of a 18-year-old patient referred to our Corneal and External Disease Department who complained of dry eye symptoms and with a suspicion of Sj?gren's syndrome. She had amblyopia of the right eye, consequence of corneal leucoma over the visual axis secondary to a fingernail traumatism inflicted by herself in childhood. On the ophthalmologic examination corneal sensitivity was absent in both eyes. Severe dry eye and breakup time less than four seconds. Diagnosis of congenital corneal anesthesia was established, secondary to trigeminal anesthesia found on neurological evaluation of facial sensitivity. She also showed sudden movements of the chin which evidenced sensorial pathology of the trigeminal nerve. The general ophthalmologist and specially anterior segment specialists must perform tests for corneal sensitivity during the routine eye examination.     

Local anesthesia for vitreoretinal surgery

A new technique for retrobulbar anesthesia for use during vitreoretinal surgery is described. A blunt 19-gauge cannula is used to directly inject the anesthetic agent into the retrobulbar space via a sub-Tenon's approach. The method reported herein virtually eliminates the possibility of complications from the administration of a standard retrobulbar block and allows prolonged vitreoretinal surgery to be performed under local anesthesia. We report the results of our first fifty-eight cases of vitreoretinal surgery performed using this technique.     

表面麻醉方式在白内障超声乳化术中的应用

目的:对白内障超声乳化术采用两种不同麻醉方式来完成手术。根据术后并发症少、安全、省时、痛苦少的比较来选择一种相对安全的麻醉方式。方法:回顾分析2009-03/2010-03我院经治白内障患者361例398眼的临床资料。采用白内障超声乳化术随意分为两组。分别采用球后麻醉、表面麻醉。结果:球后麻醉组显效184例、有效11例。表面麻醉显效190例、有效13例。术中并发症:后囊破裂:球后麻醉5眼,表面麻醉6眼。球后出血:球后麻醉1眼。角膜水肿:均在1wk内恢复。结论:白内障超声乳化术采用表面麻醉安全、省时、患者痛苦少、避免了球后麻醉经常报道的并发症。     

眼球筋膜囊下麻醉联合表面麻醉在眼科手术中的应用

目的:评价眼球筋膜囊下麻醉联合表面麻醉行各种常见眼科显微手术的安全性和有效性。方法:对246例246眼使用眼球筋膜囊下麻醉联合表面麻醉后,进行各种眼科手术,观察麻醉效果及其并发症。结果:麻醉效果:Ⅰ级221眼占89.84%,Ⅱ级20眼占8.13%,Ⅲ级5眼占2.03%,无1例发生麻醉并发症。结论:眼球筋膜囊下麻醉联合表面麻醉行眼科显微手术安全性高,麻醉效果好,麻醉并发症少,是一种值得推广的麻醉方法。     

Respiratory arrest and convulsions after peribulbar anesthesia.

We present a case in which a rare and serious complication with respiratory arrest and convulsions occurred after peribulbar anesthesia for cataract surgery. To our knowledge, respiratory arrest has been described as a complication only of retrobulbar, not peribulbar, anesthesia. Anesthesiologists trained in airway maintenance and ventilatory support should be available for immediate help when a peribulbar block is performed.     

表面麻醉联合结膜下麻醉在抗青光眼术中的应用

目的：探讨表面麻醉和结膜下麻醉进行青光眼手术的可行性，分析其镇痛效果和安全性。方法：对83例146眼青光眼手术用0．5％爱尔凯因眼液表面麻醉和2％利多卡因结膜下浸润麻醉，总结分析其麻醉效果。结果：用于青光眼手术，镇痛效果良好，能避免球后麻醉的并发症，简化了麻醉和手术步骤，缩短了手术时间。结论：表面麻醉加结膜下麻醉对常规抗青光跟手术是一种有效、安全、简便易行的麻醉选择，值得推广应用。     

Phacoemulsification in vitrectomized eyes under topical anesthesia

PURPOSE: To study phacoemulsification in vitrectomized eyes under topical anesthesia, assessing anesthetic and intraoperative characteristics and complications. METHODS: A prospective study was performed on 52 eyes of 51 patients who underwent phacoemulsification of cataract with intraocular lens implantation under topical anesthesia, having previously undergone pars plana vitrectomy. Surgical and anesthetic observations and complications were recorded, as were visual outcomes. RESULTS: Ninety-two percent of patients had improved visual acuity postoperatively with only one patient having visual loss as a result of surgery. The most common intraoperative observations were of a deep anterior chamber, posterior capsular plaques, posterior synechiae, and nuclear sclerotic cataracts. Topical anesthesia proved satisfactory in 96%, with only two patients requiring intracameral lignocaine 1%; no patients required conversion to injection anesthesia. There were no major operative or postoperative complications. CONCLUSIONS: Phacoemulsification in vitrectomized eyes can be challenging, but is visually rewarding. Topical anesthesia proved satisfactory for the vast majority of cases, with none of our patients requiring conversion to injection anesthesia.     

Retrobulbar hemorrhage after sub-Tenon's anesthesia

We present a case of retrobulbar hemorrhage from uneventful, infranasal, sub-Tenon's anesthesia before cataract surgery. To our knowledge, this is the first report of such a complication.     

基础麻醉在小儿睑板腺囊肿手术中的应用

目的:探讨基础麻醉下行小儿睑板腺囊肿手术的临床疗效,为治疗小儿睑板腺囊肿提供参考。方法:回顾性分析我院近3a来收治的56例睑板腺囊肿患儿的病例资料,所有患儿在基础麻醉下行睑板腺囊肿刮除术,并进行术后随访。结果:所有睑板腺囊肿患儿均治愈,无麻醉意外,均为一期手术愈合,局部包块消失。所有患儿均进行0.5a以上随访,无1例复发。结论:基础麻醉下行小儿睑板腺囊肿手术安全可靠,复发率低,患儿无痛苦,值得推广。     

Comparative study between topical anesthesia and sub-Tenon's capsule anesthesia for cataract surgery

AIM OF THE STUDY: We performed a prospective study to compare two techniques of local anesthesia: topical and subtenon anesthesia. Twenty-five patients underwent cataract surgery on both eyes by phakoemulsification and insertion of foldable lenses in the capsular bag. The second eye was operated 24 hours after the first one. We evaluated patient confort, surgeon confort, surgical complications and pupillary diameter evolution during the procedure. RESULTS: 64% of patients preferred subtenon anesthesia procedure. Surgeon confort was better with subtenon anesthesia. No surgical complications occurred in either group. The pupillar diameter evolution was different, decreasing for about 25% for topical anesthesia and 15% for subtenon anesthesia. CONCLUSION: Subtenon anesthesia is more comfortable for the patient: deeper anesthesia, reliable, longer lasting; light tolerance is better. It is also more comfortable for the surgeon: better pupillar dilatation during the procedure. Topical anesthesia has inconstant efficiency.     

表面麻醉联合结膜下麻醉在小梁切除手术中的应用

目的:探讨表面麻醉联合球结膜下麻醉方法行青光眼小梁切除术的可行性并对其效果进行评价。方法:对82例118眼青光眼患者用4g/L倍诺喜表面麻醉结合球结膜下麻醉行青光眼小梁切除术,观察麻醉效果及术中术后并发症。结果:全部患眼均能达到理想的麻醉镇痛效果,顺利完成手术,术中未出现常规麻醉可能出现的局部及全身并发症。结论:表面麻醉联合球结膜下麻醉行青光眼小梁切除术是一种安全、可靠、有效、简便易行的麻醉选择,值得推广应用。     

表面麻醉及球周麻醉下超声乳化白内障吸除联合人工晶状体植入术的比较

目的：评价表面麻醉下超声乳化白内障吸除及人工晶状体植入术的安全性和效果。方法：两组共375例（400只眼）白内障分别在表麻下及球周麻醉下施行超声乳化吸除及人工晶状体植入术,对术后视力,术中及术后并发症进行分析。结果：两组术后1天、1周、3个月视力无显著差异;关发症：后囊破裂及角膜水肿发生率,两组间相差不显著;球周麻醉组发生眶内出血2只眼,暂时性上睑下垂26只眼,暂时性复视9只眼。结论：表面麻醉下超声乳化术是安全有效的。在熟练掌握超声乳化手术的基础上,表面麻醉下手术较球周麻醉下更安全、快捷。     

Globe penetration during loco-regional anesthesia: prevalence and review of cases

AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.     

筋膜下麻醉小梁切除术

目的:探讨筋膜下麻醉行小梁切除术的有效性及安全性。方法:在连续58例(60眼)青光眼小梁切除术中分别应用表面麻醉、球后麻醉、筋膜下麻醉各20眼,观察麻醉效果、并发症情况。结果:表面麻醉组患者术中在上直肌牵引缝线、巩膜电凝、周边虹膜切除、结膜缝合时有不同程度痛感,筋膜下麻醉、球后麻醉组患者术中无明显痛感,筋膜下麻醉组1眼、球后麻醉组2眼术中出现一过性黑矇,球后麻醉组术中出现球后出血1眼,术后短暂性上睑下垂2眼。结论:小梁切除术采用筋膜下麻醉具有麻醉效果好、并发症少的优点,是理想麻醉方法。     

Retrobulbar hemorrhage after sub-Tenon's anesthesia

We present a case of retrobulbar hemorrhage complicating sub-Tenon's anesthesia in a patient receiving oral anticoagulants. To our knowledge, this has been described only once in the literature.     

上方球周麻醉联合表面麻醉白内障囊外摘除及人工晶状体植入术

目的:探讨上方球周麻醉联合表面麻醉白内障囊外摘除术的安全性及优越性。方法:选取2005-06/2008-12在我科接受白内障手术的患者,将所有患者随机分成3组,分别采用不同麻醉方式,手术方式均为白内障囊外摘除并植入后房型IOL,手术中观察麻醉效果,并术后随访3d观察视力和结膜反应。A组:上方球周麻醉联合表面麻醉(126眼);B组:上方结膜下浸润麻醉联合表面麻醉(89眼);C组:球后麻醉(86眼)。结果:三组全部286例301眼患者,手术全程均获得良好的麻醉效果。后囊破裂,A组和B组明显优于C组;术后结膜反应,A组和C组明显优于B组;术后视力,A组和B组明显优于C组。结论:上方球周麻醉联合表面麻醉白内障囊外摘除术是安全而优越的。     

筋膜下麻醉小梁切除术

目的：探讨筋膜下麻醉行小梁切除术的有效性及安全性。方法：在连续58例（60眼）青光眼小梁切除术中分别应用表面麻醉、球后麻醉、筋膜下麻醉各20眼,观察麻醉效果、并发症情况。结果：表面麻醉组患者术中在上直肌牵引缝线、巩膜电凝、周边虹膜切除、结膜缝合时有不同程度痛感,筋膜下麻醉、球后麻醉组患者术中无明显痛感,筋膜下麻醉组1眼、球后麻醉组2眼术中出现一过性黑矇,球后麻醉组术中出现球后出血1眼,术后短暂性上睑下垂2眼。结论：小梁切除术采用筋膜下麻醉具有麻醉效果好、并发症少的优点,是理想麻醉方法。     

Orbital regional anesthesia

Orbital regional anesthesia is a useful and safe modality for providing excellent operating conditions for the surgeon and painless, pleasant circumstances for the patient. It is especially suited for patients who are extremely sensitive and who could not tolerate topical anesthesia or a sub-Tenon's block without deep sedation. Both intraconal and extraconal techniques can be used safely and effectively if proper precautions are taken to enter the safest areas of the orbit and to avoid the vascular areas and the deep orbit where structures are tightly packed and thus more easily harmed. Thorough knowledge of orbital anatomy and understanding of the globe-orbit relationship of every patient are necessary to perform this form of regional anesthesia. In addition, knowledge of the effects and side effects of the anesthetics and adjuvants is also required.     

Local anesthesia in ophthalmic surgery

In recent years anesthesia modalities have changed in ophthalmic surgery. A growing trend toward the use of topical anesthesia in cataract surgery is apparent. The present-day techniques used in ophthalmic surgery are retrobulbar anesthesia, peribulbar anesthesia, subtenon anesthesia, and subconjunctival anesthesia as injection techniques, topical anesthesia using drops, gel, or sponge, and intracameral anesthesia. Injectable anesthesia (RBA, PBA, STA) provides a higher level of analgesia and globe akinesia. With injection techniques the risks of vis a tergo and anesthetic complications increase; the level of analgesia after topical anesthesia could be improved by supplementation with i.v. narcotics.