Abstract
Anesthesia for ophthalmic procedures involves an understanding of the local structures of the eye and various sensory and motor nerve blocks that may be used to facilitate procedures or improve post-procedural pain. Historically, retrobulbar injection of local anesthetic was the gold standard for anesthesia and akinesia, though newer techniques such as peribulbar and sub-Tenon’s blocks have reduced the risks associated with the originally described retrobulbar approach. Nerve blocks of the branches of the ophthalmic and maxillary divisions of the trigeminal nerve, collectively termed periorbital blocks, are commonly used in oculoplastics procedures or for the management of postoperative pain. Less commonly, motor nerve blocks of the facial nerve at various points along its path can be performed if required for a particular procedure. During ophthalmic procedures involving the extraocular muscles, extra care must be taken to manage the oculocardiac or trigeminovagal reflex, which may lead to bradycardia and cardiac injury secondary to rapid increase in vagal tone.
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Dhodapkar, R.M., Jin, A., Liu, J. (2023). Acute Pain Management Protocol for Ophthalmic Procedures. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_18
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