Anaes · Ophthalmic anaesthesia
Ophthalmic regional blocks: retrobulbar, peribulbar, sub-Tenon
Also known as Ophthalmic regional blocks: retrobulbar, peribulbar, sub-Tenon · Orbital regional anaesthesia · Brainstem anaesthesia eye block
Exam-exhaustive ophthalmic regional anaesthesia for ANZCA Final: orbital anatomy, retrobulbar versus peribulbar versus sub-Tenon versus topical choices, local anaesthetic pharmacology, anticoagulation decisions, and crisis drills for brainstem anaesthesia, retrobulbar haemorrhage, and globe perforation.
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Target exams
Red flags
- Retrobulbar: dense akinesia, higher risk.
- Peribulbar: larger volume, lower risk, slower.
- Sub-Tenon: blunt cannula, favourable safety.
- Brainstem anaesthesia: apnoea/unconsciousness — ventilate.
- Globe perforation: high myopes at risk.
Meet the patient
A 74-year-old receives a retrobulbar block for cataract surgery. Three minutes later he stops responding, and the saturation falls. The block was textbook; the orbit looks fine; the patient is simply not breathing.[1][2]
This is brainstem anaesthesia, and it is an airway emergency first, not an eye problem. Life-threatening complications of ophthalmic regional anaesthesia are the reason an anaesthesiologist must be available for these lists. The one question that decides his next thirty seconds is the only one that matters: are you ventilating him? Everything else — the block comparison, the anticoagulation logic, the canthotomy drill — builds on the reflex to oxygenate first when an eye-block patient goes quiet.[1][2]
References8ShowHide
- [1]Jaichandran V Ophthalmic regional anaesthesia: A review and update Indian journal of anaesthesia, 2013.PMID 23716759
- [2]Kallio H, Rosenberg PH Advances in ophthalmic regional anaesthesia Best practice & research. Clinical anaesthesiology, 2005.PMID 15966494
- [3]Pucchio A, Pur DR, Dhawan A, et al. Anesthesia for ophthalmic surgery: an educational review International ophthalmology, 2023.PMID 36436168
- [4]Mohankumar A, Rajan M Role of hyaluronidase as an adjuvant in local anesthesia for cataract surgery Indian journal of ophthalmology, 2023.PMID 37417102
- [5]Saumier N, Lorne E, Dermigny F, et al. Safety of needle regional anaesthesia for anterior segment surgery under antiplatelet agents and anticoagulants therapies Annales francaises d'anesthesie et de reanimation, 2010.PMID 21112731
- [6]Arnold RW The Oculocardiac Reflex: A Review Clinical ophthalmology (Auckland, N.Z.), 2021.PMID 34194223
- [7]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
- [8]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet (London, England), 2008.PMID 18479744