Globe Akinesia Research Articles

Effects of addition of fentanyl to lidocaine plus adrenaline during peribulbar anaesthesia for cataract surgery: A prospective study

Background: Local anaesthesia is most commonly used for cataract surgery in adult patients. Different combinations of local anesthetic agents and adjuvants have been used to provide adequate anaesthesia and analgesia. This study assessed the effect of adding 25 µg fentanyl to lidocaine with adrenaline mixture on the onset and duration of anaesthesia in adult patients undergoing cataract surgery under peribulbar anaesthesia. Methods: This was a double blind, randomized controlled study. Adult patients aged 40 years and above with American Society of Anesthesiologists Physical Status Classes 1 and 2 undergoing cataract surgery under peribulbar block (PB) were studied. Sixty-six patients were randomized into two equal groups. Group A had 25 µg fentanyl (0.5 mL) added to 6 mL of 2% lidocaine with adrenaline while Group B had sterile water 0.5 mL added to 6 mL of 2% lidocaine with adrenaline for PB. Onset and duration of lid akinesia, globe akinesia, globe anaesthesia, Numerical Rating Scale (NRS) pain score, time to analgesia request as well as patient and surgeon satisfaction were assessed. Results: The differences in the onset of lid akinesia, globe akinesia, and globe anaesthesia between the two groups were statistically significant (P ≤ 0.001, respectively). The mean duration of globe akinesia and globe anaesthesia was longer in Group A as compared to Group B (P = 0.008 and P = 0.009, respectively). Statistically significant differences in median NRS scores were found at the 4th, 5th, and 6th h (P = 0.001, respectively). The mean duration to analgesia request was 238.1 ± 65.5 min in Group A compared to 207.2 ± 49.1 min in Group B (P = 0.034). Conclusion: The addition of 25 µg fentanyl to 2% lidocaine plus adrenaline mixture improved the quality of peribulbar anaesthesia and is recommended in Nigerian adults scheduled for cataract surgery under peribulbar anaesthesia to improve their surgical experience.

Comparative study between rocuronium and magnesium sulfate as adjuvants to local anesthetics for peribulbar block

Background & Objective: Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, the prolonged onset of orbital akinesia and the frequent need for block replenishment are considered drawbacks. We aimed to investigate the impact of adding rocuronium and magnesium sulfate to a commonly used local anesthetic combination on the onset of corneal anesthesia and the degree of lid and globe akinesia during peribulbar block in ocular surgeries.
 Patients and Methods: This prospective double-blinded randomized study was conducted in the ophthalmic surgery operating theater, Ain Shams University Hospital from January 2019 to April 2020. We enrolled 75 patients from both sexes, with American Society of Anesthesiology (ASA) physical status I–III, ages 40-80 y, and an axial globe length less than or equal to 26 mm planned for cataract surgery under peribulbar block in the study following institutional ethical board approval and written informed patient consents. Patients were randomly divided into three groups, 25 patients per group, based on the drugs they received: Group O (control group): received local anesthetic + 0.9% normal saline (1 ml). Group M: received local anesthetic + magnesium sulphate 50 mg in normal saline. Group R: received local anesthetic + rocuronium at a dose of 0.06 mg/kg (maximum 5 mg) in normal saline.
 Results: Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00 ± 1.22 min) than control group and magnesium sulfate group (9.00 ± 1.47 and 9.00 ± 1.15 min) respectively, (P < 0.001); Moreover, no significant difference was noted between control group and magnesium sulfate group. In addition, no relevant difference was reported regarding duration of surgery between the groups.
 Conclusion: During cataract surgery, the addition of rocuronium to the local anesthetic mixture in the peribulbar nerve block has been found to enhance ocular akinesia and corneal anesthesia. Furthermore, the use of rocuronium demonstrated a significantly faster onset and shorter time needed to achieve the appropriate conditions to initiate the surgical procedure compared to the use of magnesium sulfate. Addition of magnesium sulfate showed good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery.
 Key words: Cataract; Magnesium Sulfate; Peribulbar Block; Rocuronium
 Citation: Nagy M, Abo El-Ella S, El-Shafey MA, Helal AM, Zekry MR. Comparative study between rocuronium and magnesium sulfate as adjuvants to local anesthetics for peribulbar block. Anaesth. pain intensive care 2024;28(1):55−61; DOI: 10.35975/apic.v28i1.2157
 Received: February 18, 2023; Reviewed: July 30, 2023; Accepted: December 23, 2023

Comparative efficacy of mepivacaine vs. bupivacaine added to lignocaine plus hyaluronidase for percutaneous peribulbar injection in cataract surgery

Background: Peribulbar anesthesia had been developed as a safer, easier, and effective alternative to retrobulbar anesthesia that provides ocular akinesia and anesthesia.
 Objective: This study aimed to compare the efficacy of mepivacaine 3% – lidocaine 2% hyaluronidase mixture with that of bupivacaine 0.5% – lidocaine 2% - hyaluronidase to produce optimal operative and post-operative conditions in patients receiving single peribulbar injection for cataract surgery.
 Patients and Methods: In this randomized, double -blind study, 90 adult patients were assigned to one of two groups (M and B), each comprising 45 patients. Study participants received 6-8 ml combination of equal parts of either mepivacaine 3% (Group M) or bupivacaine 0.5% (Group B) both with lidocaine 2% and hyaluronidase 25 IU/ml. Akinesia was assessed with a 12-point scale at 2, 5, 10 and 15 min after injection. Onset of sensory block, time to start surgery, pain and requirement for supplemental injection were also assessed.
 Results: Group M showed better akinesia scores than Group B and the onset of globe akinesia and sensory block were significantly faster in Group M. The duration of globe and lid akinesia was longer in Group B (159.16 ± 5.71 min and 150.02 ± 4.42 min, respectively) than in Group M (142.89 ± 6.52 min and 135.69 ± 4.81 min, respectively) and this showed statistical significance (P < 0.001). The percentage of patients who required supplementary injection was significantly higher in Group B (7 patients) compared to that in Group M (2 patients).
 Conclusion: Using a mixture of mepivacaine and lidocaine gives perfect globe akinesia and quicker establishment of appropriate conditions to start cataract surgery and shortens the block onset time with faster recovery compared with the addition of bupivacaine to lidocaine in peribulbar anesthesia.
 Trial registration: Registered at http:// www.pactr.org; No. PACTR201810828658359. Dated: October8, 2018.
 Abbreviations: ASA PS - American Society of Anesthesiologists Physical Status; PACU - Post Anesthesia Care Unit; VRS - Verbal Rating Scale; PBA - Peribulbar Anesthesia
 Key words: Peribulbar block, Cataract extraction, Mepivacaine, Lidocaine, Bupivacaine.
 Citation: Saleh AN, Haiba Ali Ibrahim DM, Zekry MR. Comparative efficacy of mepivacaine vs. bupivacaine added to lignocaine plus hyaluronidase for percutaneous peribulbar injection in cataract surgery. Anaesth. pain intensive care 2023;27(5):464−470; DOI: 10.35975/apic.v27i5.2167
 Received: April 09, 2023; Reviewed: August 08, 2023; Accepted: August 18, 2023

Ketamina frente a midazolam como adyuvante para el bloqueo peribulbar utilizando una única inyección inferonasal en los pacientes sometidos a vitrectomía: ensayo controlado aleatorizado

Introduction and objectivesThis study aimed to assess the safety and efficacy of midazolam and ketamine as adjuvants to the peribulbar block in vitreoretinal surgeries. Patients and methodsThis randomized controlled trial included 93 adult patients undergoing vitreoretinal surgeries performed with peribulbar anaesthesia. Patients were randomly allocated to 3 groups (31 participants each): control (standard anaesthetic mixture), midazolam (standard mixture+midazolam), and ketamine (standard mixture+ketamine). The primary outcomes were onset of globe akinesia and duration of analgesia. Secondary outcomes were duration of motor blockade, onset of corneal anaesthesia and lid akinesia, and changes in vital data (blood pressure, oxygen saturation, and pulse rate). ResultsThe ketamine group vs. the control and midazolam groups showed the most rapid onset of lid and globe akinesia (p<0.001) and corneal anaesthesia (0.7±0.2 vs. 1.5±0.5 and 1.2±0.4, respectively; p<0.001) and the longest duration of both analgesia (3.7±0.6 vs. 2.3±0.4 and 3.1±0.6, respectively; p<0.001) and akinesia (3.8±0.5 vs. 3.0±0.4, and 3.7±0.5, respectively; p<0.001). The midazolam group showed better outcomes than controls, but the drug was less effective than ketamine. There were no significant differences in vital data among groups (p>0.05). ConclusionsKetamine is an effective adjuvant for peribulbar blockade. It enhances both motor and sensory blockade by hastening onset and prolonging duration. These effects are desirable in lengthier ophthalmic procedures such as vitreoretinal surgeries. The effects of ketamine were superior to those of midazolam.

Fentanyl as an adjuvant to the local anesthetic in the peribulbar block for vitrectomy operations

ABSTRACT Background Adding certain drugs to the local anesthetics (LA) in peribulbar block (PBB) increases its intensity and duration of action, so we did this research to assess the impact of fentanyl addition to the LA in PBB for vitrectomy. Methods Forty patients were divided into: Control group: They got 9.5 ml of 0.5% bupivacaine (6 ml), 2% lidocaine (1.5 ml), 45 IU hyaluronidase (in 1.5 ml lidocaine), and 0.5 ml saline. Fentanyl group: They got the same medications plus 0.5 ml (25 mcg) of fentanyl instead of the saline. Our primary outcome was the duration of the block, and our secondary outcomes were the start of the motor block, scores for globe and lid akinesia, the quality of the block, scores for patient and surgeon satisfaction, postoperative VAPS, and the first request for analgesia and complications from the drugs used or the technique. Results The start of the motor block was significantly rapid in the fentanyl group. Additionally, there were notable variations in the length and intensity of the block between the two groups. The postoperative pain score was lower in the fentanyl group. While it was acceptable in the control group, the block quality was perfect in the fentanyl group. Complete patient satisfaction happens more often in the fentanyl group. There were no complications reported. Conclusion Fentanyl, when added to LA mixtures in PBB in vitrectomy, decreased the onset, increased the duration of lid and globe akinesia, and improved the quality of analgesia without causing any complications.

Comparison of Efficacy and Safety of Subtenon’s Anaesthesia with and without Hyaluronidase in Bilateral Cataract Patients

Background: The effect of subtenon’s block with the usage of hyaluronidase in terms of analgesia and akinesia was studied in different sets of people and the results were not satisfactory in all of them .This study eliminates bias and mitigates the confounding factors such as age, sex, pain threshold of a person, anatomical variations when done on different individuals. Objectives: To evaluate the efficacy of subtenon’s anaesthesia with hyaluronidase in group A patients and without use of hyaluronidase in group B undergoing cataract surgery in terms of Globe and lid akinesia, analgesia, onset and duration of anaesthesia intra operatively and to document complications related to subtenon’s anaesthesia. Methods : 39 patients (78 eyes) who fulfil inclusion criteria were selected and subtenon’s anaesthesia with hyaluronidase during the first eye cataract surgery followed by other eye subtenon’s anaesthesia without hyaluronidase was adopted. the study is done at RLJH, Kolar in ophthalmology department which is a teritiary setting hospital. In both groups Analgesia was graded between 0-4 grades and globe akinesia was graded between 0-3 grades and lid movements was graded between 0-2 grades. Study design used is non randomized study. Results: Analgesia (p = 0.008), globe akinesia (p = 0.002)at 15 mins ,lid akinesia (p=0.027) at 10 mins were good in Group A and it was statistically significant. The rate of onset of akinesia, patient and surgeon satisfaction were better in case of Group A . Complications were equal in both the groups showing no role of hyaluronidase in the complications and relating them to subtenon’s. Conclusions: Hyaluronidase has shown better onset of akinesia, good intraoperative analgesia , good globe and lid akinesia. Keywords: Subtenon’s block , Hyaluronidase, Akinesia, Analgesia.

EFFICACY OF ADDITION OF MAGNESIUM AS AN ADJUVANT TO LOCAL ANAESTHETICS IN PERIBULBAR BLOCK: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND STUDY

Introduction: Topical, regional or general anesthesia can be used for ocular surgery. Among regional blocks, Peribulbar block is a good choice as it provides efficient anesthesia with good lid and globe akinesia with low incidence of complications.1 However the time for onset of akinesia with Peribulbar block is much longer in comparison to retro bulbar block,2which may lead to a delay to start the surgery. The incidence of inadequate analgesia is also more frequent with Peribulbar block2 in comparison to retro bulbar block, which may lead to the requirement of supplementary injection before the start of surgery or intraoperatively. Aims And Objectives: To evaluate the effect of addition of magnesium sulphate to standard local anesthetics mixture for peribulbar blocks in ophthalmic surgeries. Material And Methods: 60 patients who underwent ocular surgery under local anesthesia admitted at Malla Reddy Narayana Multispecialty Hospital, Hyderabad from May2018- october2018(6 months) were enrolled in the study.It was Prospective Randomized controlled double blind study.Inclusion criteria was patients between 20-70 years of either sex with ASA group 1-3 with both anterior and posterior chamber surgery under peribulbar block.Exclusion criteria were patient with mental retardation, allergic to local anesthetics, history of bleeding disorder, cardiac and respiratory diseases and ASA group4-5. Results: After studying 60 patients, out of which 30 patients included in control group (Group NS) and 30 patients in study (Group MS) group,a systematic statistical analysis done for Age and All patients were in age group of 20-70 years. Mean age was 59.0667 +- 7.08049 in the control group (Group NS) and 58.1667 +- 5.73605 in study group (Group MS). The p-value 0.591,which is statistically nonsignificant. Discussion:Anaesthesia plays a vital role in ophthalmic surgery.Most ophthalmic surgeries are carried out under local anaesthesia although topical anaesthesia is soon gaining popularity.The goal of anaesthesia in opthalmic surgery is to provide adequate analgesia and akinesia.Peribulbar block has been used widely for ophthalmic surgery as it is safer than a retrobulbar block. The time for onset of akinesia with peribulbar block is much longer in comparison to retrobulbar block2, which may lead to a delay to start the surgery.The incidence of inadequate analgesia is also more frequent with peribulbar block2 in comparison to retrobulbar block, which may lead to the requirement of supplementary injection before the start of surgery or intraoperatively. Conclusions: Faster onset of globe and lid akinesia after addition of Magnesium sulphate to the mixture of local anaesthetics in peribulbar block.The duration of globe and lid akinesia is prolonged but difference is not statistically significant in Group MS as compared to Group NS.

Comparison of image quality of corneal and retinal optical coherence tomography using sedation and general anesthesia protocols with or without retrobulbar anesthesia in horses.

To compare image quality and acquisition time of corneal and retinal spectral domain optical coherence tomography (SD-OCT) under 3 different sedation-anesthesia conditions in horses. 6 middle-aged geldings free of ocular disease. 1 randomly selected eye of each horse was evaluated via SD-OCT under the following 3 conditions: standing sedation without retrobulbar anesthetic block (RB), standing sedation with RB, and general anesthesia with RB. Five regions of interest were evaluated in the cornea (axial and 12, 3, 6, and 9 o'clock positions) and fundus (optic nerve head). Three diagnostic scans of predetermined quality were obtained per anatomical region. Image acquisition times and total scans per site were recorded. Corneal and retinal SD-OCT image quality was graded on a subjective scale from 0 (nondiagnostic) to 4 (excellent). Mean values for the standing sedation without RB, standing sedation with RB, and general anesthesia conditions were 24, 23, and 17, respectively, for total cornea scan attempts; 23, 19, and 19 for total retina-scan attempts; 14.6, 13.2, and 9.2 minutes for total cornea scan time; 19.1, 9.2, and 13.0 for total retina scan time; 2.0, 2.3, and 2.5 for cornea grade; and 2.7, 2.9, and 2.5 for retina grade. The RB facilitated globe akinesia and improved the percentage of scans in frame and region of interest accuracy for retinal imaging via OCT in horses. Retrobulbar blocks improved clinical image acquisition while minimizing motion artifact.

Dexmedetomidine versus magnesium sulphate as an adjuvant to local anesthesia in single-injection percutaneous peribulbar anesthesia for cataract extraction

BackgroundThe aim of the study was to evaluate the impact of addition of dexmedetomidine or magnesium sulphate to the standard local anesthetics mixture as a primary objective and to compare between both as a secondary objective utilizing the single-injection percutaneous technique for peribulbar block. In this prospective randomized double-blinded clinical trial (RCT), sixty patients, both sexes, aged 45 to 75, with an ASA of I to III, were scheduled for cataract extraction operation. They were divided into three equal groups; each received a single injection peribulbar block of a mixture of 0.5% bupivacaine (3 ml) + 2 percent lidocaine (3 ml) + 120 IU hyaluronidase + (control group (C): 0.5 ml of normal saline; group D: 50 μg of dexmedetomidine; group M: 50 mg of magnesium sulphate in 0.5 ml) with a total injected volume of 7 ml each. The duration of sensory, motor block, need for supplementary doses, hemodynamics, and satisfaction of patients and surgeons were assessed.ResultsFor the primary outcome, both the dexmedetomidine and magnesium groups revealed statistically significant differences from the control group with shorter onsets of sensory block and lid akinesia (p value< 0.001 for both), shorter onset of globe akinesia for dexmedetomidine (p value<0.001) and for magnesium sulphate (p value=0.022), prolonged duration of lid and globe akinesia and sensory block (p value<0.001), better patient satisfaction (p value=0.044) but insignificant difference regarding surgeons’ satisfaction (p value= 0.117) and a less frequent, but statistically insignificant need for supplementary injection (p value=0.075). The demographic and clinical hemodynamics and oxygen saturation parameters were comparable between the three groups. For the secondary outcome, dexmedetomidine was superior to magnesium sulphate regarding onset of globe and lid akinesia (p value= 0.047 and 0.003, respectively), and durations of globe akinesia and sensory block (p value= 0.02 and 0.016, respectively). No complications related to the drugs or procedure were recorded.ConclusionsWhen compared to 50 mg magnesium sulphate, dexmedetomidine at a dose of 50 μg is a superior adjunct to local anesthetic combination in peribulbar block for cataract procedures in terms of start and duration of peribulbar block.

Ketamine versus magnesium sulphate as an adjuvant to local anesthetics in the peribulbar block for posterior segment surgeries: a randomized controlled study.

The use of an adjuvant to local anesthetics in the peribulbar block may improve block characteristics. The aim of this double-blinded, parallel-group, randomized, controlled trial was to evaluate the safety and efficacy of ketamine versus magnesium sulphate as adjuvants to the local anesthetic mixture of peribulbar block in patients scheduled for vitreoretinal surgeries. A total of 126 patients scheduled for vitreoretinal surgery were randomly allocated as either ketamine (GK, N.=42), magnesium sulphate (GM, N.=42), or control (GC, N.=42) groups. The primary outcomes were the onset and duration of globe akinesia, duration of lid akinesia, and onset of sensory block. Secondary outcomes included time to start surgery, duration of analgesia, intraocular pressure, and patient and surgeon satisfaction. The use of either ketamine or magnesium significantly shortened the onset of globe akinesia, enhanced the onset of sensory block, prolonged the duration of globe and lid akinesia, minimized the time required to start surgery, and increased the total analgesic time. The effect of magnesium was significantly more pronounced on durations of globe and lid akinesia as well as analgesia, whereas ketamine significantly shortened the time required to start surgery. Both patient and surgeon satisfaction were significantly improved with the use of either drug. In vitreoretinal surgeries the use of either ketamine or magnesium sulphate as adjuvants to the local anesthetic mixture of peribulbar block improved the onset, duration, and quality of the block, offered better patient and surgeon satisfaction, and was not associated with drug adverse effects or surgical complications.

EFFECT OF USING FENTANYL AS AN ADDITIVE WITH THE LOCAL ANAESTHESTIC MIXTURE IN PERIBULBAR BLOCK FOR CATARACT SURGERIESA PROSPECTIVE RANDOMIZED CONTROL STUDY

INTRODUCTION: Cataract surgery is one of the most commonly performed surgery in the elderly patients. Regional anesthesia is safe, reliable, provide adequate akinesia and analgesia of the eye, a good postoperative pain relief and a shorter hospital stay. The various regional anesthetic techniques used in ophthalmic surgeries are peribulbar block, retrobulbar block, sub tenon's block, subconjunctival block and topical corneo-conjunctival anesthesia. Due to its safer approach, the peribulbar block is most commonly. Addition of an opioid like fentanyl to the anesthetic preparation will provide a faster onset of lid and globe akinesia, faster onset of sensory blockade, increase the duration of analgesia and reduce the need for rescue analgesia postoperatively. AIM OF THE STUDY: To evaluate the effect of addition of fentanyl to the local anesthetic mixture in peribulbar block in cataract surgery. MATERIALS AND METHODS: This study was done in the Department of Anesthesiology in collaboration with the Department of Ophthalmology in Kanyakumari Government Medical College from January 2019 to December 2019. Patient posted for cataract surgery were allocated into two groups by randomization (30 each). Group S – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 0.5ml normal saline. Group F – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 25 mcg Fentanyl (0.5 ml). The Parameters related to the study such as Onset of lid akinesia, Onset of globe akinesia, Onset of sensory blockade, Duration of analgesia by VAS score, Level of sedation by Ramsay sedation score, vital parameters – SpO , pulse rate, respiratory rate, blood pressure and any 2 Complications were recorded. RESULTS: We found that the demographic parameters were comparable and statistically insignicant. The preoperative hemodynamic parameters like the systolic and diastolic blood pressure, pulse rate, SpO2, respiratory rate were statistically insignicant and comparable. The mean onset of lid akinesia was 5.8 ± 1.76 mins and 3.13 ± 1.25 mins in Group S and Group F respectively. The mean onset of globe akinesia was found to be 7.46 ± 2.22 mins and 4.2 ± 1.60 mins in Group S and Group F respectively. The mean onset of sensory blockade was 6.8 ± 1.24 mins and 4.93 ± 1.63 mins in Group S and Groups F respectively. Thus the onset of globe and lid akinesia and the onset of sensory blockade was faster in Group F compared to Group S. The mean VAS scores were statistically signicant (P&lt;0.001) between both the groups at 1 hour, 1.5 hour, 2 hour, 4 hour, 6 hour postoperatively and it was found that Group F has a lower VAS score when compared with Group S. The VAS score at 8 hour and 10 hours postoperatively were statistically insignicant (p&gt;0.05) in both the groups. The mean duration of analgesia was 4.56 ± 1.65 hours in Group S and 7.63 ± 2.55 hours in Group F and was found to be statistically signicant(P&lt;0.001). CONCLUSION: Based on this study, we can conclude that there is a faster onset in the lid akinesia, globe akinesia, in the onset of sensory blockade and a substantial increase in the duration of analgesia when fentanyl is used as an additive along with the local anesthetic mixture in peribulbar block for cataract surgery

To suture or not to suture? Does globe immobilisation technique affect clinical outcome in stereotactic radiosurgery for uveal melanoma?

Introduction Stereotactic radiosurgery (SRS) is a valuable treatment option for uveal melanoma, offering excellent tumour control rates and eye preservation. Its efficacy relies upon accurate localisation of the tumour, which is challenging in the mobile eye. Various methods of globe immobilisation have been used, including non-invasive devices, such as eye movement tracking and suction cups, but common practice is to use local anaesthetic block with or without transconjunctival suturing of the extraocular muscles. Some studies have suggested that the addition of muscle suturing to local anaesthetic block provides better immobilisation of the globe, when compared to anaesthetic block alone. Controversy exists regarding the clinical relevance of this observation and ocular oncologists differ in their choice of immobilisation technique. Methods In order to establish if the addition of muscle suturing to local anaesthetic block improves clinical outcomes, we performed a retrospective review of all cases that underwent SRS for uveal melanoma over a 10-year period (May 2008 to May 2018). Based on surgeon preference, all patients received either local anaesthetic block plus muscle suturing (Group A) or local anaesthetic block alone (Group B) to induce globe akinesia. Outcomes assessed were primary treatment failure, tumour recurrence, secondary enucleation and death rate. Results In our cohort of 290 eyes; 118 patients were in group A and 172 patients were in group B. There were no cases of primary treatment failure in either group. With a minimum of 24 months follow-up, only 3 patients experienced tumour recurrence (1 in group A and 2 in group B). There was no significant difference in recurrence, enucleation and all-cause death rates between the two groups. Conclusion Our retrospective review suggests that although extraocular muscle suturing may be considered by some units to provide superior globe immobilisation for SRS, it does not alter the clinical outcome.

To compare peribulbar and subtenon anaesthesia in patients undergoing cataract surgery

To compare peribulbar and subtenon anaesthesia in patients undergoing cataract surgery. In a hospital based randomised comparative interventional study, patients who underwent cataract surgery were randomised into two groups, one receiving peribulbar and the other subtenon anaesthesia. Pain during administration, pain during surgery, chemosis, subconjunctival haemorrhage globe akinesia were noted and compared in the two groups. Any other complications which occur also noted. The pain during administration was significantly lesser in subtenon injection as compared to peribulbar anaesthesia. Pain during surgery was comparable in the two groups. Incidence of subconjunctival haemorrhage and chemosis was more in subtenon injection as compared to peribulbar anaesthesia. Globe akinesia was achieved more effectively in subtenon injection as compared to peribulbar injection. The subtenon anaesthesia is comparable to peribulbar anaesthesia with few additional advantages and is recommended as safe and effective alternative to peribulbar anaesthesia for cataract surgery.

Adjuvant ketorolac to peribulbar anesthesia in cataract surgery: a comparative study

Purpose The aim of this study was to evaluate the effect of adding ketorolac to peribulbar anesthesia versus conventional peribulbar anesthesia in cataract surgery. Patients and methods This is a prospective randomized comparative study that recruited patients with visually significant cataract and no other ocular or systemic conditions that may influence the ocular sensation. Patients were scheduled for phacoemulsification. They were randomly assigned into three groups. In the first group (GI), an anesthetic mixture of lignocaine, bupivacaine, hyaluronidase, and ketorolac was utilized. In the second group (GII), a mixture of lignocaine, bupivacaine, and hyaluronidase was used, whereas in the third group (GIII), a mixture of lignocaine, bupivacaine, and ketorolac was used. The onset of globe anesthesia and akinesia and the duration of globe akinesia were recorded. In addition, intraoperative pain and postoperative pain experienced by the participants were assessed using the numerical rating scale after patient instructions. Results The study included 114 patients. The onset of globe anesthesia was significantly faster in GI (6.5±1.3 min) compared with GII and GIII (8.1±1.5 and 8.8±1.9 min, respectively, P Conclusion Ketorolac was an effective adjuvant to peribulbar block. It effectively shortened the onset of globe anesthesia, with no significant effect on globe akinesia.

Tramadol as an adjuvant to peribulbar anesthesia

Background A large number of additives have been used as an adjuvant to local anesthetic (LA) mixture in peribulbar block to fasten the onset, enhance the potency, and prolong the duration of the block to cover the long duration of vitreoretinal surgeries and provide better postoperative analgesia. The authors designed a prospective, randomized, double-blind, controlled clinical trial to assess the effect of adding tramadol 20 mg to standard LA mixture concerning the onset of lid and globe akinesia, time for satisfactory block, and duration of postoperative akinesia and analgesia. Patients and methods A double-blind randomized study was done on 80 American Society of Anesthesiologists I and II patients scheduled for elective vitreoretinal surgery. Patients were chosen randomly into two groups, with 40 patients in each group. Group I (control group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) with 1 ml normal saline to a total volume of 10 ml. Group II (tramadol group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) supplemented with 20 mg tramadol in 1 ml normal saline to a total volume of 10 ml. The onset and duration of lid and globe akinesia and optimum time to begin surgery were recorded, in addition to postoperative visual analog score, duration of analgesia, and time to first rescue analgesic request. Results The results show statistically significant differences between the two groups, as tramadol group had faster onset of akinesia, better akinesia score, and shorter time needed to start surgery. In addition, tramadol group also showed significantly prolonged postoperative analgesia and akinesia with lower median pain score and less postoperative analgesic requirements. Conclusion The present study concluded that tramadol is a safe adjuvant to LA in peribulbar block that fastens the onset and prolongs the duration of lid and globe akinesia and improves the quality of analgesia without any obvious adverse effects.

Effect of fentanyl addition to local anesthetic mixture in peribulbar block for cataract surgery

Background In peribulbar regional anesthetic blocks, injection of local anesthetic mixtures alone provide unsatisfactory surgical conditions as regards block intensity and duration especially for relatively lengthy operations. So, additives may improve the quality of the block and provide good postoperative analgesia. Aim To examine the effect of adding fentanyl to local anesthetics in peribulbar block on the onset and duration of lid and globe akinesia (primary outcome) and postoperative analgesia (secondary outcome). Patients and methods Patients were classified randomly allocated in a blind manner into two groups; each group contained 30 patients. The control group received a measure of 7 ml [3 ml lidocaine 2%+0.5 ml hyaluronidase (150 U)+2.5 ml bupivacaine 0.5%+1 ml saline] which was used locally and the fentanyl group received a measure of 7 ml [3 ml lidocine2%+0.5 ml hyaluronidase (150 U)+2.5 ml bupivacaine 0.5%+1 ml saline containing 20 μg fentanyl] which was used locally. Results Statistically significant decreased mean time of complete akinesia decreases the mean time to sensory block in the fentanyl group compared with the control group. Conclusion Fentanyl is an effective drug as an additive to local anesthetic mixture in peribulbar anesthesia, as it shortens the onset time of corneal anesthesia and globe akinesia, prolongs block duration, and good postoperative analgesia.

Fentanyl versus midazolam as additive to local anesthetic mixture for peribulbar block during posterior segment surgery in adult patients a prospective randomized double-blind study

ObjectivesTo evaluate analgesic and hemodynamic outcome of fentanyl or midazolam as additives to local anesthetic mixture (LAM) for peribulbar block (PBB) during posterior chamber surgery.MethodsOne hundred thirty-two ASA status I to III adult patients aged 50–75 years scheduled for posterior segment surgery (intraocular foreign body and elective vitrectomy) were enrolled in this prospective, randomized, double-blind trial from which 12 patients were excluded. After signing a written fully informed consent for study participation, patients were grouped into 3 groups (40 patients in each group); group C received local anesthetic mixture plus 1 ml plain saline, group F received local anesthetic mixture plus 25 μg fentanyl in 1 ml saline and group M received local anesthetic mixture plus 1 mg midazolam in 1 ml saline. The primary outcome was the onset time of eyelid and globe akinesia. Also, the duration of the block was assessed in the three studied groups. Intraoperative and postoperative hemodynamic measures were assessed. Postoperative analgesia was hourly-assessed using Visual analogue scale (VAS) and rescue analgesia was provided at visual analogue score of > 3.ResultsThe number of patients who had fast eyelid and globe akinesia was significantly higher with significantly lower total 15-min score in group F than the other groups. Intraoperative and postoperative hemodynamic measures were non-significantly different between studied groups. Duration of the block was significantly longer in groups F and M than group C with significantly longer duration in group F. The number of patients who required postoperative rescue analgesia was significantly lower with significantly lower number of requests in group F than the other groups.ConclusionAdditives to local anesthetic mixture during peribulbar block provided satisfactory anesthetic outcome than local anesthetic mixture alone. Fentanyl was superior to midazolam in terms of significantly speed up onset, longer block duration with significantly longer postoperative analgesia and lesser consumption of rescue analgesia. Both additives provided adjusted hemodynamic measures comparable to the control group.Trial registrationPan African Clinical Trials Registry (PACTR201708002496243) registered 03/08/2017 retrospectively.

Peribulbar Block Using Dexmedetomdine versus Magnesium Sulphate as Additives to Local Anesthetics for Cataract Surgery

Background: peribulbar block is commonly used for cataract surgery in adults, most commonly local anesthetics were injected into peribulbar space, but using only local anesthetics for peribulbar anesthesia is associated with delayed onset of globe akinesia and, short duration of analgesia and frequent need of block supplementation Objective: to assess the efficacy and safety of addition of dexmedetomidine versus magnesium sulphate to local anesthetic mixture for peribulbar block in cataract surgery. Patients and Methods: the patients were divided randomly into two equal groups: Dexmedetomidine group (D Group) included 30 patients who received 50 µg dexmedetomidine adjuvant to local anesthetics mixture (lidocaine and bupivacaine). Magnesium sulphate group (M Group) included 30 patients who received 50mg of Magnesium sulphate adjuvant to local anesthetics mixture (lidocaine and bupivacaine). Results: The addition of Dexmedetomidine or Magnesium sulphate to local anesthetic in cataract surgery accelerates the onset of corneal anesthesia and globe akinesia . The decrease in the IOP is more in D Group . No significant changes in the hemodynamic measurements in both groups Conclusion: Use of 50ug dexmedatomedine or 50mg magnesium sulphate 10% with mixture of lidocaine 2% plus bupivacine 0.5% for peribulbar anesthesia in cataract surgery enhances the onset of globe anesthesia and akinesia . Dexmedetomidine causes more decrease in intraocular pressure magnesium sulphate.

Rocuronium versus cisatracurium as adjuvants to local anesthetic in peribulbar-induced akinesia

Background and objectives Peribulbar anesthesia is widely used in cataract surgery, but the beginning of akinesia is much slower and slower compared with retrobulbar technique. The effect of using adjuvant to the peribulbar block for the development of improved conditions in the absence of any adverse effects and in fastening the onset of akinesia has been implicated. We investigate the effect of the use of rocuronium, cisatracurium, and hyaluronidase as adjuvants for the local anesthetic on peribulbar-induced akinesia in relation to the grade of akinesia. Patients and methods A total of 135 women were assigned for cataract surgery to three groups (45 patients in each group), who received local eye anesthesia of a mixture (8 ml) containing equal amounts of Marcaine 0.5% and lidocaine 2%, containing hyaluronidase 15 IU/ml plus 0.5 ml saline 0.9% (group C); a mixture (8 ml) containing equal parts of 0.5% Marcaine and 2% lidocaine plus 0.5 ml cisatracurium (1 mg) (group A); and a mixture (8 ml) containing equal parts of 0.5% Marcaine, 2% lidocaine plus 0.5 ml rocuronium (5 mg) (group R). Lid akinesia, globe akinesia, hemodynamics, and adverse effects were evaluated among groups. Results After 1 min of injection, the number of patients reaching total akinesia was 15 (33%) with rocuronium, nine (20%) with cisatracurium, and zero (0%) in the control group. After 3 min of injection, the total number of individuals achieving total immobility was 21 (46%) with rocuronium, 15 (33%) with cisatracurium, and six (13%) in the control group. After 5 min of injection, the number of patients reaching total akinesia was 33 (73%) with rocuronium, 27 (60%) with cisatracurium, and 21 (46%) with the control group. At the 10th minute after injection, the number of individuals reaching total akinesia was 39 (86%) with rocuronium, 33 (73%) with cisatracurium, and 30 (66%) with control. In groups of rocuronium and cisatracurium, the total akinesia is relatively more frequent than in the control group. The number of patients with complete akinesia was higher in the rocuronium group after 10 min than in the cisatracurium and control groups, but there was no statistically significant difference among the three groups regarding lid akinesia. We did not notice any adverse effects related to the peribulbar block or the drugs used during the study. Conclusion This study demonstrated that addition of low-dose cisatracurium and rocuronium to the anesthetic drug is recommended to improve the quality of akinesia especially when hyaluronidase is not added.

Articaine versus lidocaine with and without dexmedetomidine for peribulbar anesthesia in phacoemulsification

Background The aim of this study was to compare the use of articaine versus lidocaine either with or without dexmedetomidine for peribulbar anesthesia in phacoemulsification. Patients and methods This is a prospective, randomized double-blind study that included 120 adult patients subjected to phacoemulsification with peribulbar anesthesia. They were randomly allocated into four groups: articaine (group 1, A), lidocaine (group 2, L), articaine–dexmedetomidine (group 3, AD), and lidocaine–dexmedetomidine (group 4, LD). Ocular akinesia was evaluated using Brahma scoring system. Pain assessment was carried out by four-point verbal rating score. Patient satisfaction and surgeon satisfaction were also recorded. Results Regarding the ocular movement score, a statistically significant lower score was recorded in group 3 (AD) when compared with each of the other groups. Within each group, there was a significant decrease in eyelid score at 5, 10 min and end of surgery when compared with baseline score. Regarding the mean duration of globe akinesia, it was significantly longer in group 3 (AD) (139±20.4 min) in comparison with the other groups [group 4 (LD)=120.83±21.09 min, group 1 (A)=73±10.55 min, and group 2 (L)=50.33±4.9 min]. Patient satisfaction was significantly better in group 3 (AD) and in group 4 (LD). Surgeon’s satisfaction was significantly better in group 1 (A), group 3 (AD) and group 4 (LD) when compared with group 2 (L) and in group 1 (A) and group 3 (AD) in comparison with group 4 (LD), with the best quality detected in group 3 (AD). Conclusion Articaine was superior over lidocaine for peribulbar block in achieving shorter onset and longer duration of globe akinesia and anesthesia. Addition of dexmedetomidine improved the quality of each.