|Year : 1989 | Volume
| Issue : 3 | Page : 142
Single injection anaesthesia for intra ocular surgery
Varghese Joseph, Amita Varghese
Opthalmic Surgeon, Rotary Eye Hospital, Maranda-176 102 (H.P), India
Opthalmic Surgeon, Rotary Eye Hospital, Maranda-176 102 (H.P)
Source of Support: None, Conflict of Interest: None
|How to cite this article:
Joseph V, Varghese A. Single injection anaesthesia for intra ocular surgery. Indian J Ophthalmol 1989;37:142
Retrobulbar anaesthesia causing retrobulbar akinesia in patients undergoing intraocular surgery has been reported by Martin et al.
Intraocular surgery in India is performed under local anaesthesia by majority of the surgeons. The standard technique used is a facial block as well as retrobulbar block.
At our Hospital we tried the effect of giving only a retrobulbar block for achieving both orbital akinesia and retrobulbar anaesthesia. Initially the technique was used on a selected number of patients and as results were found satisfactory, without any complications, it is now carried out as a routine for almost all cases of intraocular surgery.
| MATERIAL & METHODS
Six hundred patients operated during the last one year were given only a single retrobulbar injection of local anaesthetic agent. The technique involves giving the patient an injection of 2% Lignocaine hydro chloride with 1 % Bupivacaine (in a ratio of 3:1) with hyaluronidase and adrenalin. 5-6 ml of the solution is injected with a 35 mm long 23-24 gauge needle into the muscle cone. After the injection the eyeball is given a good massage followed by use of a pinky ball for 10 minutes. The Pinky ball is lifted off the eye ball at short intervals to relieve constant pressure over the eye.
Six hundred patients operated during the last one year were given only a single retrobulbar injection for local anaesthesia and surgery was successfully conducted in 99% of the cases. Orbicularis akinesia is adequate and perfect by this technique. The injection was considered to be successful if orbicularis function was reduced enough for surgery to be conducted safely after a single injection and lids did not move during operation. In 1 % of cases where additional facial block was required it was due to an incorrect direction of the needle or insufficient massage. The mode of action is most likely to be diffusion of the drug anteriorly during the massage.
Martin et al reported orbicularis akinesia with retrobulbar injection in a prospective study of 50 patients with a success rate of 88%. The mode of action is probably due to diffusion of the drug along the needle tract or from spread through the orbital tissue planes during ocular massage.
The advantages observed with this technique were as follows:
1. Patient requires a single injection to achieve complete anaesthesia instead of 2 or 3 injections as in conventional facial and retrobulbar block.
2. Quantity of the drug required is less.
3. The tension lowering effect is much more as massage is done for a longer period.
4. The injection is less painful during surgery and post - operatively (as compared to facial block) and there is no swelling or edema at the injection site post operatively.
5. There is no chance of facial nerve damage.
6. Less time is wasted in the operation theatre waiting for the next patient to be ready. When a large number of patients have to be operated upon the same day, the next patient can be anaesthestised before the surgeon completes surgery on the previous case and no time is lost. As bupivacaine is used the local anaesthetic effect stays for a longer period.
No serious complication occurred during surgery and post operatively except for the 0.80% incidence of retrobulbar haemorrhage which does take place with the conventional technique of local anaesthesia also.
Stephen R. Martin, Sterling S. Baker and W. Stanley Menzier Retrobulbar anaesthesia and Orbicularis akinesia; Ophthalmic Sug. 17:232-233 April, 1986.