Peribulbar Anesthesia for Blepharoplasty

Abstract

Peribulbar anesthesia for inferior blepharoplasty was used successfully in 788 selected cases over the past 9 years. This technique is largely accepted for ophthalmologic procedures, but is not yet specifically used for blepharoplasty. In the past 9 years, 788 patients ages 36 to 77 years were submitted to inferior peribulbar anesthesia for blepharoplasty procedures. Of these patients, 623 (79%) were women and 165 (21%) were men. The anesthetic procedure is performed using a needle introduced at the junction of the medial two-thirds and the lateral third of the inferior orbital rim (point A). With the patient staring forward, the needle is introduced through the lid at point A. It enters the orbital cavity just above the orbital floor periosteum until the globe equator is minimally trespassed (depth, approximately 31 mm). There, 3 ml of the local anesthetic solution (2% lidocaine + 0.5% bupivacaine) is slowly injected. None of our treated patients reported pain or discomfort during or after the surgical procedure. Immediately after inferior peribulbar anesthesia, chemosis was observed in 17 cases (2.2%) and orbital hematoma in 3 cases (0.4%). Diplopia, or a slight imaging distortion lasting a few hours may occur after inferior peribulbar anesthesia. Inferior peribulbar anesthesia for blepharoplasty offers surprising results. The surgical procedures are performed pain free, leaving the patients completely relaxed and allowing an easier surgical procedure. This technique should be performed only by highly skilled anesthesiologists or surgeons with a perfect knowledge of the complex orbital anatomy.