Peribulbar anesthesia for strabismus surgery in adult patients

Purpose: To evaluate the efficacy and safety of peribulbar anesthesia during strabismus surgery. Methods: Medical records of patients undergoing strabismus surgery and peribulbar anesthesia were reviewed. The overall efficacy of peribulbar anesthesia was evaluated as requirement of supplemental peribulbar anesthesia, impossibility to perform eye muscles surgery due to inadequate efficacy of the block and peribulbar block complications that occurred up to 6 weeks postoperatively. Presence of oculocardiac reflex (OCR) and presence of decreased visual acuity and afferent pupillary defect postoperatively were reported. Results: A total of 510 patients comprised our study group. The total amount of peribulbar injections was 717. Four patients (0.7%) required supplemental injection in the superonasal quadrant. Five of 510 (0.9%) required an anesthesiologic intervention with intravenous atropine. Eighty patients of 510 (15.6%) complained about transitory complete ptosis and/or amaurosis postoperatively. No complications were observed up to 6 weeks postoperatively. Conclusion: Peribulbar anesthesia was an effective and safe option during strabismus surgery in adult patients.

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Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study

Journal of International Medical Research ◽

10.1177/0300060520945158 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094515

Author(s):

Sun Young Shin ◽

Min Ju Kim ◽

Jin Joo

Keyword(s):

Laryngeal Mask Airway ◽

Medical Records ◽

Pediatric Patients ◽

Strabismus Surgery ◽

Adult Patients ◽

Laryngeal Mask ◽

Spontaneous Respiration ◽

Depth Of Anesthesia ◽

Oculocardiac Reflex ◽

Specific Muscle

Objective To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2) whether the depth of anesthesia influences the occurrence of the OCR and ORR in patients undergoing strabismus surgery with a laryngeal mask airway with maintenance of spontaneous respiration. Methods The medical records of patients who underwent strabismus surgery on the lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were retrospectively reviewed. Results The incidence of the OCR was not significantly different between LR and MR operations in either pediatric or adult patients. The incidence of the ORR as indexed by the tidal volume (TV) was significantly higher during MR than LR surgery in pediatric patients (29.3% vs. 10.1%, respectively). The change in TV during muscle traction and the bispectral index were significantly correlated in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively). Conclusions The OCR was not influenced by the specific muscle undergoing surgery or the depth of anesthesia. The incidence of the ORR as indexed by the TV was higher during MR surgery in pediatric patients and was positively correlated with the depth of anesthesia.

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A Comparative Study Between Single Medial Canthus Injection Using 13 x 0.45 mm Needle and Posterior Sub-Tenon Injection as Local Anesthesia Techniques for Strabismus Surgery in Adults

The Open Anesthesia Journal ◽

10.2174/2589645802014010008 ◽

2020 ◽

Vol 14 (1) ◽

pp. 8-13

Author(s):

Norhan A. Sherif ◽

Mayada K. Mohamad ◽

Ahmed A. Hannon ◽

Noha A. Osama

Keyword(s):

Single Injection ◽

Strabismus Surgery ◽

Anesthetic Technique ◽

Injection Technique ◽

Efficacy And Safety ◽

Medial Canthus ◽

Peribulbar Block ◽

Group A ◽

Peribulbar Anesthesia ◽

Group B

Background: The quality of ophthalmic anesthesia is an important component of the surgical procedure. There is no absolutely well-tolerated local eye anesthetic technique. However, it is important to choose a technique with high efficacy and safety. Objective: This study aimed to compare the efficacy and safety of peribulbar block using medial canthus single injection and posterior sub-tenon injection techniques. Methods: This prospective observational study was carried out at the Research Institute of Ophthalmology, Cairo, Egypt during the period from March to December 2018. Consecutive 60 patients of both sexes, aged >18 years-old, scheduled for bilateral strabismus surgery were enrolled in this study. In one eye of the sixty patients, medial canthus single injection peribulbar anesthesia was used (Group A), whereas posterior sub-tenon technique was applied in the other eye (Group B). Results: The median total ocular akinesia score was significantly higher in group A than in group B when assessed at 1, 3, and 5 min (p < 0.001). Each of the intraoperative (at 5 min) and postoperative pain scores showed no significant differences between the two groups (p > 0.05). However, the median scores of surgeon and patient satisfaction were significantly higher in group A compared with group B (3 vs. 2 each, p < 0.05). No patient developed occulocardiac reflex or postoperative nausea and vomiting. Conclusion: Peribulbar anesthesia by medial canthus single injection showed better akinesia of the globe than sub-tenon injection technique. Otherwise, both techniques were equally effective and safe.

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Comparing General Anesthesia with Preemptive IV Atropine vs General Anesthesia with Single Injection Peribulbar Block with Levobupivacaine 0.5% or Lidocaine 2% for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery: Randomized Control Study

QJM ◽

10.1093/qjmed/hcab086.034 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hani Ali Ezzat ◽

Galal Adel ElKady ◽

Melad Ragaey Zekry ◽

Dalia Ahmed Ibrahim ◽

Abeer Sameer Salem

Keyword(s):

General Anesthesia ◽

General Anaesthesia ◽

Pain Control ◽

Strabismus Surgery ◽

Minor Role ◽

Oculocardiac Reflex ◽

Post Operative Pain ◽

Peribulbar Block ◽

Successful Group ◽

Clinically Significant

Abstract Background Strabismus is one of the common health problems among the children. The incidence of the oculocardiac reflex decreases with age and tends to be more pronounced in young, healthy patients, which is clinically significant for pediatric as it is observed with greatest incidence in young healthy neonates and infants undergoing strabismus surgery. Objective to prevent and attenuate the oculocardiac reflex in children age group from (2yrs to 14 yrs) undergoing surgical correction for strabismus. Patients and Methods Three groups were allocated Group C received general anaesthesia combined with pre emptive atropine, Group L received general anaesthesia combined with Peribulbar block with Lidocaine 2 % and Group LB which received general anaesthesia combined with peribulbar block with Levobupivacaine 0.5%. Results In Our study we found that group L which received peribulbar lidocaine 2 % was the most successful group regarding blocking the occurrence of the OCR and with acceptable post operative pain control results. Conclusion In Our study the use of peribulbar block with lidocaine 2 % in combinations with General anaesthesia is very effective against the incidence of OCR in children undergoing strabismus surgery and superior to the Iv pre emptive Atropine with higher surgeon satisfaction while the use of peribulbar levobupivacaine 0.5% combined with general anaesthesia has a great role in post operative pain control with superior patient satisfaction, on the other hand the atropine is a very important emergency drug but our study found that it has a very minor role in both preventing the OCR and post operative pain control in addition to subjecting the patients to the tachycardia and other complications like dryness of the mouth and blushing so its not recommended by our study.

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Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults

The Open Anesthesia Journal ◽

10.2174/2589645801913010100 ◽

2019 ◽

Vol 13 (1) ◽

pp. 100-105 ◽

Cited By ~ 1

Author(s):

Norhan Aly Sherif ◽

Mayada Khairy Mohamad ◽

Sameh Galal Taher ◽

Ahmed Abdou Hannon ◽

Hesham Mohamed Salem

Keyword(s):

Magnesium Sulphate ◽

Local Anesthetics ◽

Strabismus Surgery ◽

Patient’S Satisfaction ◽

Group I ◽

Peribulbar Block ◽

Peribulbar Anesthesia ◽

Adult Strabismus ◽

Group Ii

Background: Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia. Objective: The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery. Methods: A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data. Results: The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7 vs. 3.9 ± 1.0 min, p < 0.001; 2.3 ± 0.7 vs. 4.4 ± 1.2 min, p < 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0 vs. 43.0 ± 8.5 min, p < 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0 vs. 4.0, p < 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0% vs. 25.9%, p < 0.001). Conclusion: Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.

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