Abstract
BackgroundSub-Tenon's anaesthetic is effective and reliable in producing both akinesia and anaesthesia for cataract surgery. Our clinical experience indicates that it is sometimes necessary when absolute akinesia is required during surgery to augment the block with 1–2 ml of local anaesthetic. Hypothesis was that after first injection some of the volume injected may spill out and before second injection the effect of hyaluronidase has taken place and second volume injectate will have desired effect.MethodsA prospective, randomised, control trial in which patients were randomly allocated to one of two groups. In group 1, single injection of 5 ml of local anaesthetic was injected. In group 2, 3 ml of the same anaesthetic solution was injected followed by application of gentle orbital pressure for 2 minutes. A further 2 ml of the same anaesthetic solution was injected through the same conjunctival incision. Measurement of movement in four quadrants of eye was done by the surgeon at 3 and 6 minutes. Intraocular pressure, chemosis, and subconjuctival haemorrhage were also measured.ResultsSignificant differences at 3 minutes between groups for overall movement, medial, superior, and lateral quadrants occurred. At 6 minutes no significant group differences emerged for the overall movement or for any of four quadrants.ConclusionSingle injection of local anaesthesia for sub-Tenon's block with mixture of lignocaine with adrenaline, bupivacaine and hyaluronidase was found to be superior to provide akinesia of ocular muscles compared to divided dose given by two injections. No difference in groups in terms of haemorrhage, chemosis, patient's satisfaction and intraocular pressure was found.Trial registrationTrial registration no-ISRCTN73431052
Highlights
Sub-Tenon's anaesthetic is effective and reliable in producing both akinesia and anaesthesia for cataract surgery
Our clinical experience indicates that it is sometimes necessary when absolute akinesia is required during surgery to augment the block with a second injection of local anaesthetic solution (1–2 ml)
No significant difference occurred between groups for levels of haemorrhage, chemosis and patients satisfaction
Summary
Sub-Tenon's anaesthetic is effective and reliable in producing both akinesia and anaesthesia for cataract surgery. In 1992 Stevens described a technique for sub-Tenon's anaesthesia, which entailed application of topical anaesthesia, use of an eye speculum, making a small incision in the conjunctiva, and passing a blunt cannula posteriorly in the subconjuctival space[4]. Injectate administrated at this site passes into the sub-Tenon's space. Our clinical experience indicates that it is sometimes necessary when absolute akinesia is required during surgery to augment the block with a second injection of local anaesthetic solution (1–2 ml). Our hypothesis was that a divided injection into the sub-Tenon's space would achieve greater, more consistent and more rapid motor blockade a single injection using equal volumes and mixtures of local anaesthetic solution
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