Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases

• Published in: British journal of ophthalmology 1999-01, Vol.83 (1), p.104-109
• Main Authors: Muraine, Marc, Calenda, Emile, Watt, Laure, Proust, Nicole, Cardon, Annie, Eupherte, Laurent, Brasseur, Gérard
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Local - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cataracts; Child; Corneal Transplantation - adverse effects; Corneal Transplantation - methods; Female; Humans; Intraocular Pressure; keratoplasty; Male; Medical sciences; Middle Aged; Original articles - Clinical science; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Pain; Patient Satisfaction; peribulbar anaesthesia; positive posterior pressure; Prospective Studies; suprachoroidal haemorrhage; Surgery
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.83.1.104

AIMS A prospective study was carried out in order to evaluate the efficacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions. METHODS Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9–22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied. RESULTS Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an “open sky” situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. CONCLUSION These results demonstrate that peribulbar anaesthesia offers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery.