Abstract
Needle length is an important consideration in the safe conduct of ophthalmic blocks. A shorter needle could be used to insert the local anesthetic before the globe equator in the anterior orbit and to direct the injectable posteriorly using Honan’s balloon to produce the desired effect. However, the use of pressure-reducing devices is not advisable in procedures with impaired retinal blood flow. The aim of this work was to demonstrate the effect of ocular compression with a Honan’s balloon on the quality of peribulbar anesthesia when a short needle was used. The blockades were performed in 120 patients using a 27 G, half-inch-long needle. The needle was inserted into the inferotemporal quadrant adherent to the inferior orbital notch. The 7 to 10 ml of local anesthetic solution, consisting of bupivacaine 0.5%, lidocaine 2% in a ratio of 3:2 with hyaluronidase 5 U/ml, was injected followed by application of Honan’s balloon or no compression. Ocular akinesia was assessed 10 min later; if inadequate, supplementary anesthesia was provided. No difference was detected in terms of volume injected, supplementation, and akinesia score. Under the conditions of this study, Honan’s balloon did not contribute to the quality of the anterior orbit anesthesia, and the technique can be successfully used when ocular compression is contraindicated.
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References
Budd JM, Brown JP, Thomas J, Hardwick M, McDonald P, Barber K. A comparison of sub-Tenon’s with peribulbar anaesthesia in patients undergoing sequential bilateral cataract surgery. Anaestheia. 2009;64:19–22.
Chang BY, Hee WC, Ling R, Broadway DC, Beigi B. Local anaesthetic technique and pulsatile ocular blood flow. Br J Ophthalmol. 2000;84:1260–3.
Gills JP, Hustead RF, Sanders DR. Ophthalmic anesthesia. Thorofare, NJ: Slack. 1993.
Scott R, Jakeman C, Perry S, Acharya P. Peribulbar anaesthesia and needle length. J R Soc Med. 1995;88:594–6.
Riad W. Peribulbar blockade with a short needle for phacoemulsification surgery. Acta Anaesthesiol Scand. 2009;53:247–50.
O’Donoghue E, Batterbury M, Lavy T. Effect on intraocular pressure of local anaesthesia in eyes undergoing intraocular surgery. Br J Ophthalmol. 1994;78:605–7.
Frow MW, Miranda-Caraballo IJ, Akhtar MT, Hugkulstone EC. Single injection peribulbar anaesthesia, total upper eyelid drop as an endpoint marker. Anaesthesia. 2000;55:750–6.
Bowman R, Liu C, Sarkies N. Intraocular pressure changes after peribulbar injections with and without ocular compression. Br J Ophthalmol. 1996;80:394–7.
Morgan JE, Chandna A. Intraocular pressure after peribulbar anaesthesia: is the Honan Balloon necessary? Br J Ophthalmol. 1995;79:46–9.
Ling R, Beigi B, Quinn A, Jacob J. Effect of Honan balloon compression on peribulbar anesthesia adequacy in cataract surgery. J Cataract Refract Surg. 2002;28:113–7.
Watkins R, Beigi B, Yates M, Chang B, Linardos E. Intraocular pressure and pulsatile ocular blood flow after retrobulbar and peribulbar anaesthesia. Br J Ophthalmol. 2001;85:796–8.
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The author did not receive any form of funding from any institution to carry out this study.
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Riad, W. Effect of pressure-reducing devices on the quality of anterior orbit anesthesia. J Anesth 25, 446–449 (2011). https://doi.org/10.1007/s00540-011-1114-7
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DOI: https://doi.org/10.1007/s00540-011-1114-7