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Regional anaesthesia for intraocular surgery

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Abstract

The role of anaesthetists in providing local anaesthesia for intraocular surgery has changed over the past decade. No longer confined to the interested few, more and more anaesthetists are involved in monitored care and/or are performing eye block anaesthesia. This reiew summarizes the information related to eye block anaesthesia. The salient features of the orbital anatomy important for safe conduct of eye block anaesthesia are described. The techniques for retrobulbar and peribulbar anaesthesia, including facial nerve blocks, anaesthetic mixture, types of needles, and softening the eye are presented. Complications such as retrobulbar haemorrhage, globe penetration / perforation, visual impairment, brainstem anaesthesia, muscle injury, and oculocardiac reflex are explored. The implications of anticoagulant therapy are examined. The choice between retrobulbar and peribulbar blocks and the role of anaesthetists are discussed.

Résumé

Le rôle de l’anesthésiste en anesthésie locale oculaire a changé au cours de la dernière décennie. L’anesthésie locale oculaire ne fait plus partie du domaine de quelques initiés mais intéresse de plus en plus d’anesthésistes qui veillent non seulement au monitorage mais exécutent souvent euxmêmes les blocks. Cette revue résume l’information relative aux blocks oculaires. Les caractéristiques de l’anatomie orbitale pertinentes à l’exécution des bloc de l’oeil sont décrites. Les auteurs traitent des techniques de blocs rétrobulbaire et péribulbaire, incluant le bloc du nerf facial, les mélanges anesthésiques, les types d’aiguilles. Les complications comme l’hémorragie rétrobulbaire, la pénétration et la perforation du globe, les atteintes visuelles, l’anesthésie du tronc cérébral, les blessures musculaires et le réflexe oculocardiaque sont abordés. Les conséquences de l’anticoagulothérapie sont décrites. On discute du choix à faire entre le bloc péribulbaire et rétrobulbaire ainsi que du rôle de l’anesthésiste.

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Correspondence to David H. W. Wong.

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Wong, D.H.W. Regional anaesthesia for intraocular surgery. Can J Anaesth 40, 635–657 (1993). https://doi.org/10.1007/BF03009701

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Key words

  • anaesthetic techniques: regional, retrobulbar, peribulbar, facial nerve
  • complications: haemorrhage, globe penetration, blindness, brainstem anaesthesia, oculocardiac reflex
  • surgery: ophthalmic