Peribulbar and retrobulbar combined anesthesia for vitreoretinal surgery using ropivacaine

Eur J Ophthalmol. Mar-Apr 2006;16(2):295-9. doi: 10.1177/112067210601600216.

Abstract

Purpose: To evaluate the efficacy and clinical effects of local retrobulbar anesthesia using ropivacaine in vitreoretinal surgery.

Methods: Prospective study. A total of 919 vitreoretinal operations were followed. The operations were divided into three groups, depending on the degree of anesthesia needed. Group A: Vitrectomies with episcleral procedures (208 vitrectomies for detached retina or perforating trauma). Group B: Episcleral procedures only (410 operations for detached retina without vitrectomy). Group C: Vitrectomies without episcleral surgery (301 operations for macular pucker or hole, proliferative diabetic retinopathy, or silicone oil removal). Anesthesia was administered using a 23-gauge Atkinson-type retrobulbar needle, after topical anesthesia. Six mL of the solution containing 7.5 mg ropivacaine/mL were injected into the peribulbar space, and the other 4 mL deeper, into the retrobulbar space. The degree of infiltration of the palpebral region, the motor block in the extrinsic ocular muscles, and pain felt were checked and rated.

Results: Swelling of lids was seen in 885 patients (96%); in 21 (2%) swelling was partial. In 13 patients (1%) there were no signs of infiltration. The motor block was total in 801 (87%) eyes, while 118 (12%) had reduced ocular movements. The degree of anesthesia was as follows, considering the three groups together: no pain = 855 (93%) patients; moderate pain = 44 (4%) patients; very strong pain = 20 (2%) patients. No adverse events or side effects were observed.

Conclusions: Ropivacaine used for retrobulbar-peribulbar combined anesthesia in vitreoretinal surgery showed excellent clinical efficacy as regards analgesia and muscle akinesia.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amides / administration & dosage*
  • Amides / adverse effects
  • Analgesia
  • Anesthesia, Local / methods*
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Junction / drug effects
  • Oculomotor Muscles / drug effects*
  • Orbit / drug effects*
  • Pain Measurement
  • Prospective Studies
  • Retinal Diseases / surgery*
  • Ropivacaine
  • Vitrectomy*

Substances

  • Amides
  • Anesthetics, Local
  • Ropivacaine