Duration of pain after a combination of peribulbar anesthesia and local anesthetic in the ball after enucleation or evisceration: 115 cases

Background: Peribulbar block for vitreoretinal surgery is rather associated with delayed onset of globe anesthesia, akinesia and short duration of analgesia. Objective: To compare the effect of addition of Magnesium sulphate vs dexmedetomidine to standard local anesthetics mixtures on the time of onset of Globe Anesthesia, Akinesia & analgesia duration. Patients and Methods: Ninety patients of both sexes, aged 25- 75 years, ASA I-III scheduled for vitreoretinal surgery. They were randomly allocated into 3 equal groups each received peribulbar block a mixture of Levo- bupivacaine 0.5% (3 ml) + lidocaine 2% (3 ml) +120 IU hyaluronidase + Control group (C): 0.5 ml of Normal saline. Group (M): 50 mg of Magnesium sulphate in 0.5 ml normal saline. Group (D): 50 μic of dexmedetomidine in 0.5 ml normal saline. The duration of sensory, motor block, Sedation level, Intra-ocular Pressure (IOP) and surgeon satisfaction were assessed. Results: The onset of globe anesthesia and akinesia was significantly shorter in M group in comparison with D and C Groups, with a significant increase in the duration of globe analgesia and akinesia in the D Group when compared to both M & C groups. Groups D and M showed a statistically significant decrease in the IOP at 5 min and 10 min when compared to the baseline measurement of the same groups & to C Group, no complications or adverse effects related to the drug or technique were recorded. Conclusion: Magnesium sulphate as a local anesthetic adjuvant in peribulbar block is safe and comparable to dexmedetomidine regarding the sensory and motor block duration with better cost-effectiveness and availability.

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Peribulbar versus Retrobulbar Anesthesia for Ophthalmic Surgery

Anesthesiology ◽

10.1097/00000542-200101000-00013 ◽

2001 ◽

Vol 94 (1) ◽

pp. 56-62 ◽

Cited By ~ 57

Author(s):

Jacques Ripart ◽

Jean-Yves Lefrant ◽

Jean-Emmanuel de La Coussaye ◽

Dominique Prat-Pradal ◽

Bruno Vivien ◽

...

Keyword(s):

Clinical Efficacy ◽

Local Anesthetic ◽

Clinical Studies ◽

The Other ◽

Ophthalmic Surgery ◽

Retrobulbar Anesthesia ◽

Thin Slices ◽

Human Cadavers ◽

Peribulbar Anesthesia

Background Peribulbar and retrobulbar anesthesia have long been opposed on the basis of the existence of an intermuscular membrane, which is supposed to separate the intraconal from the extraconal spaces in a water-tight fashion. A local anesthetic injected outside the cone should spread through this septum to reach the nerves to be blocked. The existence of this septum is questioned. The aim of this study was to compare the spread of a colored latex dye injected intraconally or extraconally to simulate both retrobulbar and peribulbar anesthesia. Methods The authors used 10 heads from human cadavers. For each head, one eye was injected intraconally, and the other eye was injected extraconally. The heads were then frozen and sectioned into thin slices following various planes. They were then photographed and observed. Results There was no evidence of the existence of an intermuscular septum separating the intraconal and extraconal spaces. Those two spaces appeared to be part of a common spreading space, the corpus adiposum of the orbit. Conclusions These results are in accord with the fact that clinical studies were not able to clearly demonstrate that retrobulbar anesthesia is more efficient than peribulbar anesthesia. On the basis of a similar clinical efficacy of the two techniques as a result of similar spreading of the local anesthetic injected, and a potentially higher risk of introducing the needle into the muscular cone, the authors recommend replacing retrobulbar anesthesia with peribulbar anesthesia.

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