Complications of classic double injection technique of peribulbar anaesthesia given in supine position before cataract surgery

2021 ◽  
Vol 12 (3) ◽  
pp. 88-92
Author(s):  
Shilpi Kapoor ◽  
Shagufta Rather ◽  
Dinesh Gupta
Keyword(s):  
Cataract Surgery ◽  
Supine Position ◽  
Cataract Extraction ◽  
Injection Technique ◽  
Safe Procedure ◽  
Double Injection ◽  
Peribulbar Anaesthesia ◽  
Retrobulbar Block ◽  
Department Of Ophthalmology ◽  
Peribulbar Block

Background: Peribulbar anaesthesia has almost totally replaced general anaesthesia and retrobulbar block for ocular procedures especially in adults. Peribulbar block involves injections above and below the orbit, with local anesthetic deposited within the orbit but does not enter the muscle cone. Relatively safe but it is still associated with complications which are detailed in this study. Aims and Objective: To study the complications of classic double injection technique of peribulbar anaesthesia given in supine position before cataract surgery and to find the percentage of patients achieving complete block with 7ml of anaesthetic solution given by peribulbar route. Materials and Methods: This prospective observational study was conducted on 500 patients who were admitted for undergoing cataract extraction surgery in the Department of Ophthalmology in GMC Jammu for a period of 8 months from December 2018 to July 2019. Results: It was observed that 103 patients out of 500 (20.6%) developed one or more of complications. Chemosis was the most common complication which occurred in 87 (17.4%) patients followed by subcunjunctival haemorrhage observed in 19 (3.8%) patients. Lid ecchymosis occurred in 16 (2.4%) patients. Retrobulbar haemorrhage occurred in 11 (2.2%) patients. 2 (0.4%) patients developed severe lid edema. In 2 (0.4%) patients wrong eye was given block. 1 (0.2%) patient developed CRAO. Complete akinesia was obtained in 415 (83%) patients with 7ml of block. Rest required supplementary injections. 14 (2.8%) patients did not attain full akinesia after 12ml of block. Conclusion: Peribulbar block is a relatively safe procedure for obtaining ocular analgesia and akinesia, but is still associated with complications ranging from minor lid edema and chemosis to grave events like RBH to CRAO.

scholarly journals OUTCOME OF CATARACT SURGERY IN CHILDREN

1969 ◽  
Vol 2 (1) ◽  
pp. 100-104
Author(s):  
Haroon Rashid ◽  
Faizur Rahman ◽  
Sayed Ashfaq Ali Shah ◽  
Muhammad Ali Jan
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Visual Outcome ◽  
Cataract Extraction ◽  
Difficult Problem ◽  
Posterior Chamber ◽  
Extracapsular Cataract Extraction ◽  
Delayed Presentation ◽  
Department Of Ophthalmology ◽  
Age Range

Objectives: To evaluate the management and visual outcome of cataract surgery in children. Study design: Descriptive. Material and Methods: This study included one hundred pediatric patients having cataracts over a periodof two year, from Is' January 2005 to 31 st December 2006, at the Department of Ophthalmology, SaiduTeaching Hospital, Saidu Sharif, Swat. Results: Age range was fourteen years and below. Sixty five (65%) patients were males and thirty five (35%) females. Sixty three (63%) patients had congenital or developmental cataracts and thirty seven (37%) had traumatic cataracts. Extracapsular cataract extraction (aspiration) was performed on 150 eyes. Postoperative visual acuity was recordable in 112 eyes. Acorrected visual acuity of 6/18 or better was obtained in50 (44.64%) eyes. Forty one (36.6%) eyes obtained visual acuity of 6/24 to 6/60, while in 21 (18.75%) eyesthe visual acuity remained below 6/60. The most common postoperative complication was development ofthick posterior capsule, which occurred in 51 (34%) eyes and vitreous loss in 10 (6.6%) eyes. Pupil blockglaucoma developed in 4 (2.66%) eyes. No case developed endophthalmitis. Posterior chamber IOL wasimplanted in 9 (6%) eyes. Conclusions: Management of cataracts in children is still a problem and delayed presentation leads to poorvisual outcome. The public should be educated to seek early treatment for childhood cataracts. Paramedicsand doctors should be made aware of the problem and its management. Management of unilateral cataractsis still a difficult problem. Therefore search should continue for better surgical approach and better methodsof correction of aphakia so as to achieve better visual outcome. Key words: Childhood Cataracts, Congenital Cataracts and Traumatic Cataracts.

Frequency of Pseudophakic Glaucoma in Patients with Cataract Surgery

2021 ◽  
Vol 15 (5) ◽  
pp. 1151-1153
Author(s):  
I. Abbas ◽  
A. M. Ahmed ◽  
S. M. Dayal ◽  
G. A. Sirhindi
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Cataract Extraction ◽  
Extracapsular Cataract Extraction ◽  
Fiber Layer ◽  
Cross Sectional ◽  
Department Of Ophthalmology ◽  
Keywords Cataract Surgery ◽  
Extracapsular Cataract Surgery ◽  
Layer Defect

Aim: To determine the frequency of pseudophakic glaucoma in patients who underwent cataract surgery. Study Design: Cross-sectional Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital Lahore from 1st July 2020 to 31st December 2020. Methodology: Ninety five patients of both genders with cataract surgery were enrolled and ages between 45 to 75 years. After taking written consent detailed demographics including age, sex, body mass index, intraocular pressure, and mode of surgery were recorded. Pseudophakic glaucoma was labelled in case of cataract surgery with intraocular lens implantation and intraocular pressure >21 mmHg or more in one eye along with glaucomatous optic disc or retinal nerve fiber layer defect on optical coherence tomography (OCT). Results: There were 58 (61.05%) males and 37 (38.95%) patients were females. Mean ages of patients were 62.36±9.44 years. Sixty two (65.26%) patients had extracapsular cataract extraction and 33 (34.74%) patients had phacoemulsification. Mean intraocular pressure was 19.33±8.56 mmHg. Pseudophakic glaucoma was found in 32 (33.68%) patients. Conclusion: The frequency of pseudophakic glaucoma was high in patients with extracapsular cataract surgery. Keywords: Cataract surgery, Pseudophakic glaucoma, Intraocular pressure (IOP)

EFFECT OF USING FENTANYL AS AN ADDITIVE WITH THE LOCAL ANAESTHESTIC MIXTURE IN PERIBULBAR BLOCK FOR CATARACT SURGERIESA PROSPECTIVE RANDOMIZED CONTROL STUDY

2021 ◽  
pp. 5-7
Author(s):  
M.Selvi Annie Geeta ◽  
Lakshmi K.Nair
Keyword(s):  
Blood Pressure ◽  
Cataract Surgery ◽  
Respiratory Rate ◽  
Pulse Rate ◽  
Local Anesthetic ◽  
Sensory Blockade ◽  
Vas Score ◽  
Department Of Ophthalmology ◽  
Peribulbar Block ◽  
The Mean

INTRODUCTION: Cataract surgery is one of the most commonly performed surgery in the elderly patients. Regional anesthesia is safe, reliable, provide adequate akinesia and analgesia of the eye, a good postoperative pain relief and a shorter hospital stay. The various regional anesthetic techniques used in ophthalmic surgeries are peribulbar block, retrobulbar block, sub tenon's block, subconjunctival block and topical corneo-conjunctival anesthesia. Due to its safer approach, the peribulbar block is most commonly. Addition of an opioid like fentanyl to the anesthetic preparation will provide a faster onset of lid and globe akinesia, faster onset of sensory blockade, increase the duration of analgesia and reduce the need for rescue analgesia postoperatively. AIM OF THE STUDY: To evaluate the effect of addition of fentanyl to the local anesthetic mixture in peribulbar block in cataract surgery. MATERIALS AND METHODS: This study was done in the Department of Anesthesiology in collaboration with the Department of Ophthalmology in Kanyakumari Government Medical College from January 2019 to December 2019. Patient posted for cataract surgery were allocated into two groups by randomization (30 each). Group S – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 0.5ml normal saline. Group F – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 25 mcg Fentanyl (0.5 ml). The Parameters related to the study such as Onset of lid akinesia, Onset of globe akinesia, Onset of sensory blockade, Duration of analgesia by VAS score, Level of sedation by Ramsay sedation score, vital parameters – SpO , pulse rate, respiratory rate, blood pressure and any 2 Complications were recorded. RESULTS: We found that the demographic parameters were comparable and statistically insignicant. The preoperative hemodynamic parameters like the systolic and diastolic blood pressure, pulse rate, SpO2, respiratory rate were statistically insignicant and comparable. The mean onset of lid akinesia was 5.8 ± 1.76 mins and 3.13 ± 1.25 mins in Group S and Group F respectively. The mean onset of globe akinesia was found to be 7.46 ± 2.22 mins and 4.2 ± 1.60 mins in Group S and Group F respectively. The mean onset of sensory blockade was 6.8 ± 1.24 mins and 4.93 ± 1.63 mins in Group S and Groups F respectively. Thus the onset of globe and lid akinesia and the onset of sensory blockade was faster in Group F compared to Group S. The mean VAS scores were statistically signicant (P<0.001) between both the groups at 1 hour, 1.5 hour, 2 hour, 4 hour, 6 hour postoperatively and it was found that Group F has a lower VAS score when compared with Group S. The VAS score at 8 hour and 10 hours postoperatively were statistically insignicant (p>0.05) in both the groups. The mean duration of analgesia was 4.56 ± 1.65 hours in Group S and 7.63 ± 2.55 hours in Group F and was found to be statistically signicant(P<0.001). CONCLUSION: Based on this study, we can conclude that there is a faster onset in the lid akinesia, globe akinesia, in the onset of sensory blockade and a substantial increase in the duration of analgesia when fentanyl is used as an additive along with the local anesthetic mixture in peribulbar block for cataract surgery

scholarly journals Effect of Varying Duration of Ocular Compression on Raised Intraocular Pressure following Fractionated Peribulbar Anaesthesia for Cataract Surgery

1970 ◽  
Vol 12 (4) ◽  
pp. 197-200
Author(s):  
Jaichandran Venkatakrishnan ◽  
Lingam Vijaya ◽  
Ronnie J. George ◽  
Thennarasu Maruthamuthu
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Local Anaesthetic ◽  
Ocular Surgery ◽  
Peribulbar Anaesthesia ◽  
Peribulbar Block ◽  
Digital Compression ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Aim: To evaluate the effect of fractionated peribulbar anaesthesia and varying digital ocular compression time on intraocular pressure.Methods: Forty non-glaucomatous patients aged 40 years and older planned for cataract surgery were randomly divided into 2 groups based on the duration for which the globe was compressed digitally following each injection. Patients with a history of glaucoma or those who had had previous ocular surgery were excluded. Group 1 underwent 1 minute of compression and group 2 underwent 2 minutes of compression. Local anaesthetic (2% lidocaine 5 mL, 0.5% bupivacaine 5 mL, and hyaluronidase 25 IU/mL) was injected into the inferotemporal and superomedial quadrants. Intraocular pressure was measured (3 readings with <5% SD) before peribulbar block, after inferotemporal injection, following digital compression, after superomedial injection, following digital compression again, and at 1-minute intervals without compression until the globe attained normotension.Results: The mean (SD) intraocular pressure in group 1 was significantly elevated compared with the baseline mean intraocular pressure of 19.21 mm Hg (SD, 2.82 mm Hg) throughout the procedure (p < 0.0001). In group 2, the mean intraocular pressure was not significantly elevated from the baseline mean intraocular pressure of 19.13 mm Hg (SD, 3.27 mm Hg) following compression after each injection.Conclusions: Intraocular pressure rises significantly following each 5 mL of local anaesthetic injected into the peribulbar space at both the inferotemporal and superomedial sites. Digital ocular compression given for 2 minutes after each injection makes the globe normotensive.

scholarly journals Comparison of visual outcomes in patients undergoing small incision cataract surgery versus phacoemulsification at Divisional Headquarters Hospital, New Mirpur, Azad Kashmir.

2019 ◽  
Vol 26 (08) ◽  
pp. 1365-1369 ◽  
Author(s):  
Khawaja Abdul Hamid ◽  
Shaista Habibullah
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Cataract Extraction ◽  
Extracapsular Cataract Extraction ◽  
Small Incision Cataract Surgery ◽  
Visual Outcomes ◽  
Small Incision ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
Uncorrected Visual Acuity

Cataract extraction is one of the commonest surgical procedures in Ophthalmology globally. Extracapsular cataract extraction ECCE), through a small incision (SICS), with insertion of an intraocular lens has been the most widely used method from 1990s until recently. Technological advances have led to the increasing use of phacoemulsification (PE) to emulsify and remove the lens. The technique requires a smaller incision, but requires substantial capital investment in theatre equipment. In this we compared the visual outcomes of patients undergoing both surgical techniques at a public sector hospital in Mirpur. Study Design: Single-center retrospective cohort study. Setting: Department of Ophthalmology, Divisional Headquarters Hospital, New Mirpur, AJK. Period: Cataract surgery cases from January 2018 to February 2019. Materials and Methods: 196 patients with age related cataract were included in the SICS group and 115 in the phacoemulsification group. The main comparative outcome was uncorrected visual acuity 4 weeks after surgery. Results: In this study, it was found that the primary post-operative visual outcome for small incision cataract surgery and phacoemulsification was comparable in terms of uncorrected visual acuity. No statistically significant difference was found in the proportions of SICS and phacoemulsification groups when compared for UCVA of 6/9 or better, 6/60 or better and 6/60 and worse.

Pediatric Cataract Surgery: Comparison between Ages at Surgery and Contrast Sensitivity Outcomes

2019 ◽  
Vol 43 (1) ◽  
pp. 50
Author(s):  
Aquirina Caesari Putri ◽  
Rozalina Loebis
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Contrast Sensitivity ◽  
Cataract Extraction ◽  
Significant Negative Correlation ◽  
Natural World ◽  
P Value ◽  
Pediatric Cataract ◽  
Low Contrast ◽  
Significant Difference

Background: Pediatric cataracts are major causes of children’s blindness. Surgery has proven to be beneficial in terms of visual function prognosis. Contrast sensitivity evaluation after surgery is as important as visual acuity considering that natural world consists of various objects in low-to-medium contrasts. The purpose of this study is to analyze the difference of contrast sensitivity outcomes based on ages at surgery. Method: Retrospective data of children with pediatric developmental cataract from July 2013 to November 2015 were collected. All children who underwent cataract surgery at 60-months-old or less were randomized into two groups, ≤24 months and >24-to-60 months. Contrast sensitivity was then examined with preferential-looking method using Hiding Heidi low-contrast test face chart. The main outcome measures were contrast sensitivity of both groups. Age-at-evaluation, cataract onset, duration of follow-up, duration of deprivation and visual acuity were also noted. Result: Of 14 children (23 eyes), 11 eyes (47,8%) were in ≤24 months group, 12eyes (52,2%) were in >24-to-60 months group. All eyes underwent cataract extraction and similar type of intraocular lens implantation. Mean age-at-surgery was 28,2 months±16,8 (SD). Mean contrast sensitivity for each group was 47,50 %±42,29 and 18,33%±27,38, respectively, with p-value 0,031. Further analysis of Spearman’s correlation test demonstrated significant negative correlation (rs = -0,559; p = 0,006) between the two groups. Conclusion: There was statistically significant difference in contrast sensitivity between those who underwent surgery at ≤24 months and >24-to-60 months. Children who underwent surgery at older ages tend to have better contrast sensitivity afterwards.

scholarly journals Comparison between Single- and Double-Injection Technique for Ultrasound-Guided Supraclavicular Block: A Randomized Controlled Study

2021 ◽  
pp. 1-6
Author(s):  
Suresh Kumar Vallapureddy ◽  
Gajanan Fultambkar ◽  
V. Rajeswar Rao ◽  
Vinay Kukreja ◽  
Rammohan Gurram ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Motor Block ◽  
Brachial Plexus Block ◽  
Demographic Data ◽  
Controlled Study ◽  
Injection Technique ◽  
Double Injection ◽  
Performance Time ◽  
Plexus Block

<b><i>Background:</i></b> The supraclavicular approach to brachial plexus block is a commonly employed regional anesthesia technique for providing surgical anesthesia and postoperative analgesia for patients undergoing upper limb fractures. With ultrasound (US) guidance, the success rate of the block is increased, and complications like pneumothorax and vascular puncture are minimized. The block can be performed using single injection at the corner pocket or double injection, that is, half of the drug at the corner pocket and the remaining half at the cluster of brachial plexus divisions. <b><i>Methods:</i></b> After institutional ethics committee approval, we randomized 40 patients scheduled with fractures for elective upper extremity surgery under US-guided supraclavicular brachial plexus block. Twenty patients received 30 mL of local anesthetic at the corner pocket (group SI), and 20 patients received 30 mL of local anesthetic using the dual-injection technique in divided doses (group DI). Demographic data, time to block performance, time to sensory and motor block, total anesthesia-related time (TART), block success, and failure were compared between both groups. <b><i>Results:</i></b> The demographic data were comparable between both groups. The DI group had a significantly faster onset than the SI group (<i>p</i> = 0.0172). There was a statistically significant lesser performance time in group SI than in group DI (<i>p</i> &#x3c; 0.034). The sensory and motor block achieved was comparable between both groups. <b><i>Conclusion:</i></b> The success rates in both the SI and DI techniques are comparable. The DI technique results in a faster onset and hence a shorter TART; however, it may not be clinically relevant.

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