Abstract
Twelve thousand regional anaesthetics for cataract extraction and intraocular lens implantation surgery were administered by one anaesthetist over a period of 52 months in a free-standing outpatient surgicalfacility. The ophthalmologist, who did all the operations, assessed the qualify of the blocks using an objective scoring system which is described. The first 3,595 patients had retrobulbar and seventh nerve blocks. The following 1,640 patients had higher volume retrobulbar blocking alone. The next 3,478 had peribulbar blocks, followed by 2,226 who had a modifiedform of peribulbar blocking. A final group of 1,061 had a combination of peribulbar and periorbital blocks with added retrobulbar injection if indicated. As the method of blocking evolved, the more closely was the goal of safe, painless and effective regional anaesthesia approached. The requirements for effective anaesthesia of this type are presented, the complications described and the importance of familiarity with the anatomy of the orbit and its contents stressed.
Résumé
Douze mille anesthésie régionales pour extraction de cataractes et implantation intraoculaire de lentilles ont été accomplies par un anesthésiste pour une période de 52 mois dans une clinique de chirurgie ďun jour. Ľophtalmologiste, qui a accompli toutes les opérations a évalué la qualité des blocs utilisant une échelle objective décrite dans cet article. Les premiers 3,595 patients ont subi des blocs rétrobulbaires et du septième nerf. Les 1,640 patients subséquents ont reçu seulement un bloc rétrobulbaire avec des volumes plus élevés. Les 3,478 patients ont reçu des blocs péribulbaires et 2,226 ont reçu un bloc péribulbaire modifié. Un dernier groupe de 1,061 a reçu une combinaison ďun bloc péribulbaire et périorbital avec la possibilité ďune réinjection rétrobulbaire si indiquée. Avec ľévolution des techniques de blocage on a pu se rapprocher du but final ďatteindre une anesthésie régionale efficace, sécuritaire et sans douleur. Les conditions ďune anesthésie efficace de ce type sont présentés, les complications sont décrites et ľimportance ďune reconnaissance anatomique de ľorbite et de son contenu est mise en valeur.
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Hamilton, R.C., Gimbel, H.V. & Strunin, L. Regional anaesthesia for 12,000 cataract extraction and intraocular lens implantation procedures. Can J Anaesth 35, 615–623 (1988). https://doi.org/10.1007/BF03020350
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DOI: https://doi.org/10.1007/BF03020350
Key words
- anaesthesia
- block assessment
- regional anaesthesia
- ophthalmic
- anaesthetic technique
- peribulbar anaesthesia
- periorbital anaesthesia
- regional
- retrobulbar anaesthesia
- anaesthetics
- local
- bupivacaine
- epinephrine
- hyaluronidase
- lidocaine
- complications
- brain stem anaesthesia
- contralateral orbital block
- extraocular muscle paresis
- orbital haemorrhage
- retinal vascular occlusion
- scleral perforation
- shivering