Prospective analyses of peribulbar block anaesthesia in intraocular surgery using 13 mm long 26 gauge needle
Manoj Vasudevan, Mohanarangam
IP International Journal of Ocular Oncology and Oculoplasty
unpublished
Intraocular surgeries are usually done under local anaesthesia using either topical anaesthetic eye drops or using blocks like retrobulbar, peribulbar or a sub-tenon's injection of local anaesthetic agents. The aim of this study is to demonstrate the safety and efficacy of a 13 millimeter long, 26 gauge needle in peribulbar block anaesthesia for intra ocular surgeries, hence a prospective analysis of peribulbar block anaesthesia using 13 millimeter, 26 gauge needle for 350 patients undergoing
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... tra ocular surgery was considered. All the blocks and surgeries were performed by the same surgeon. The number of injections needed to produce adequate anaesthesia, the volume of the anaesthetic agent needed, the onset and the duration of action of the anaesthetic drug and the complications with this technique were analyzed. Intraocular surgeries consisted of primary cataract extraction using phacoemulsification/manual small incision sutureless cataract extraction with placement of posterior chamber intraocular lens implantation, secondary intraocular lens implantation with scleral fixation intraocular lens in aphakic patients, combined cataract extraction with intraocular lens implantation with trabeculectomy and evisceration of the eye with artificial prosthetic implants for painful blind eyes. Introduction The techniques of ocular local anaesthesia (1) for performing various intraocular surgeries include retrobulbar block, peribulbar block, sub-tenon's anaesthesia, sub-conjunctival injections and topical anaesthesia with or without additional sedation. (2-4) The first two techniques mentioned above are the most commonly used ones, giving good operative comfort for both the surgeon and patient. It is common to use a 24 or 25 millimeter (mm) long needle to administer the peribulbar block. The possibility of inadvertently positioning such a needle into the retrobulbar space has been suggested. This unintentional injection would risk the potentially serious side effects that those using the peribulbar technique seek to avoid. The safety and effective use of 16 mm, 25 or 27 gauges (G) needle has been previously described. (5) There are many studies on many sizes and gauge of needles which are tried to find out an ideal needle for the best results of peribulbar anaesthesia. (5-7) The aim and purpose of this study is to demonstrate the safety and the efficacy of a 13 mm, 26 G needles in performing peribulbar block anaesthesia for intraocular surgeries. So, in peribulbar block anaesthesia, local anaesthetic agents are injected within the orbit but do not enter the muscle cone. The mechanism of the block was explained by Koornneef, who demonstrated that the inter muscular septum between the recti muscles were incomplete and hence permitted the local anaesthetic agents injected outside the muscle cone but within the orbit, to spread centrally. He has also described about the anatomy of the fascial spaces around the globe.
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