Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 5207
  • Home
  • Print this page
  • Email this page

   Table of Contents      
ORIGINAL ARTICLE
Year : 1991  |  Volume : 39  |  Issue : 2  |  Page : 48-49

One point low volume peribulbar anaesthesia versus retrobulbar anaesthesia. A prospective clinical trial


H.B.M.G. Hospital, Borivli(W), Mumbai, India

Correspondence Address:
N S Athanikar
H.B.M.G. Hospital, Borivli(W), Mumbai
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 1916978

Rights and PermissionsRights and Permissions
  Abstract 

A prospective trial was conducted on 142 patients who underwent cataract surgery, to compare the efficacy of a single point, low volume peribulbar with that of retrobulbar anaesthesia. It was found that peribulbar anaesthesia is as efficacious as retrobulbar anaesthesia without the associated complications. It also avoids the facial block used by most ophthalmologists to supplement a retrobulbar block, thus markedly reducing the post-operative patient discomfort as well as the total volume of anaesthetic used.

Keywords: Peribulbar, Retrobulbar Anaesthesia, Cataract Surgery.


How to cite this article:
Athanikar N S, Agrawal V B. One point low volume peribulbar anaesthesia versus retrobulbar anaesthesia. A prospective clinical trial. Indian J Ophthalmol 1991;39:48-9

How to cite this URL:
Athanikar N S, Agrawal V B. One point low volume peribulbar anaesthesia versus retrobulbar anaesthesia. A prospective clinical trial. Indian J Ophthalmol [serial online] 1991 [cited 2019 Dec 10];39:48-9. Available from: http://www.ijo.in/text.asp?1991/39/2/48/24472



Click here to view


Click here to view


Click here to view


Click here to view

  Introduction Top


Various studies have been documented to emphasise the salientfeatures of retrobulbar anaesthesia and some for peribulbar anaesthesia in ophthalmology. However, little data is available comparing the two. The present study was designed as a single blind prospective trial to compare the two modes of anaesthesia for cataract surgery.

In the past, most methods of peribulbar anaesthesia were multipoint and thus cumbersome [1]. We have used the one point, low volume approach of Weiss et al (1989). Thus in addition to proving the efficacy of perib­ulbar anaesthesia in comparison with retrobulbar anaes­thesia, this study also proves the utility of the single point, low volume method. This method of anaesthesia is advantageous in that it eliminates all the various complications of retrobulbar anaesthesia (eg. retrobulb­ar haemorrhage, central artery occlusion, ocular perfor­ation, subarachnoid injection, brain stem anaesthesia, cardiopulmonary arrest) and the postoperative pain and edema of a facial block [2],[3],[4],[5],[6],[7].


  MATERIAL & METHODS Top


142 patients who underwent cataract surgery were ran­domly divided into 2 groups with the aid of a randomisa­tion chart.

Group A: Retrobulbar anaesthesia. Group B: Peribulbar anaesthesia.

The administration and evaluation were done by separ­ate individuals.

Mixture administered:

Group A: 5 cc Lignocaine (2%) + 1:200000 Adrenaline + 150 IU Hyaluronidase injected with a 23 no. 3.75 cm needle placed at the junction of the medial 2/3 and the lateral 1/3 of the inferior orbital rim and directed backwards and up­wards. Aspiration was done before injection to check I.V. penetration.

Group B: 5cc Lignocaine (2%) + 1:200000 Adrenaline + 150 IU Hyaluronidase injected with a 25 no. 1.5 cm needle in the same manner as retrobul­bar injection except that it was directed stra­ight down with the needle buried upto the hub at the skin.

No facial blocks or additional injections for lid akinesia were used. Following the ocular injection massage was done by applying a super pinky ball to exert uniform pressure for 10 minutes with intermittent release of pressure in both groups of patients.

At the end of 10 minutes the eyes were evaluated for:

1) Lid akinesia

2) Globe akinesia

3) Globe anaesthesia

Each of the above was graded on a scale of 0 to +++ as follows:

0 Akinesia/Anaesthesia inadequate to continue.

+ Akinesia/Anaesthesia not ideal but adequate

to proceed

++ Akinesia/Anaesthesia not ideal but more than

adequate proceed.

+++ Total akinesia/anaesthesia.

Any complications of anaesthesia were also noted.


  Results Top


Of the 142 consecutive patients of cataract surgery 71 received peribulbar and 71 received retrobulbar anaes­thesia. The scale evaluation of each parameter is as tabulated in [Table - 1].

There was no significant difference in the assessment between the two methods i.e. peribulbar anaesthesia is as effective as retrobulbar anaesthesia.

However, the incidence of chemosis [Table - 2] was significantly higher in the patients who received peribulbar anaesthesia. One patient of Group A had a retrobul­bar haemorrhage.


  Discussion Top


This study proves one point, low volume peribulbar anaesthesia to be as effective as retrobulbar anaes­thesia.

In addition to completely eliminating the need for addi­tional facial and lid anaesthesia it also has some ad­vantages over retrobulbar anaesthesia [1].

1) Injection is less painful.

2) Reduces total quantity of anaesthetic agent re­quired in comparison with the conventional retrobul­bar and facial block technique. (However, a recent study has shown a retrobulbar block without facial block also to be effective)

3) Anaesthetic spreads diffusely in the posterior orbit, therefore less posterior pressure and thus a softer eye.

4) Eliminates the risk of retrobulbar haemorrhage.

A clinically insignificant point probably of some concern to a new person would be that the time of onset of anaesthesia/ akinesia in peribulbar technique is 8-10 minutes unlike retrobulbar anaesthesia which shows a quicker onset.

Though the exact mechanism of action is unknown it is probably a combination of direct inhibition of the neuro­muscular transmission from orbital diffusion into the extraocular muscles themselves and diffusion into the III, IV, V, VI nerves and the ciliary ganglion.

The method of peribulbar injection utilised in this study is less cumbersome than peribulbar injections used by other authors and simpler than combined retrobulbar and lid injections even when this is used without the facial block.

The complications of retrobulbar anaesthesia are usual­ly due to direct/indirect trauma to the intraconal struc­tures as well as perforation of the globe [5]. All of these are completely eliminated with the use of a 1.5 cm. needle to inject in the peribulbar region, as it is then not possible to even accidentally enter the cone and cause damage to structures within.

Thus peribulbar injection is not only as effective as retrobulbar anaesthesia but safer due to the non-entry into the muscle cone.

 
  References Top

1.
Davis D B. Mendal M R : Posterior peribulbar anaesthesia: An alternative to retrobulbar anaesthesia. Indian Journal of Ophthalmology ; 1989 : 37 59-61  Back to cited text no. 1
    
2.
Meyers E F : Brain stem anaesthesia after retrobulbar block. Arch. Ophthalmol ; 1985;103:1278-1279.  Back to cited text no. 2
    
3.
Ahn J C, Stanley J A : Subarachnoid injection as complication of retrohul­bar anaesthesia. Am J Ophthalmol: 1987;103:225-230.  Back to cited text no. 3
    
4.
Klein M.L., Jampol L.M . Condon P.L., et al: Central retinal artery occlusion following retrobulbar anaesthesia. Am J Opthalmol: 1982. 93 : 573.  Back to cited text no. 4
    
5.
Schneider M.E., Miltstein D.E., et al: Ocular perforation following retrobul­bar anaesthesia. Am J Ophthamol : 1988 : 106: 35-40.  Back to cited text no. 5
    
6.
Friedberg H. L.. Kline O.R. Jr., : Contralateral amaurosis following retrobul­bar block. Am J Ophthalmol ; 1986; 101: 688-690.  Back to cited text no. 6
    
7.
Rosenblatt R.M., May D.R., Barsoumian K : Cardiopulmonary arrest following retrobulbar block. Am J Ophthalmol: 1980; 90:425-427.  Back to cited text no. 7
    



 
 
    Tables

  [Table - 1], [Table - 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
MATERIAL & METHODS
Results
Discussion
References
Article Tables

 Article Access Statistics
    Viewed2775    
    Printed105    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal