Peribulbar Block Research Articles

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.

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings.

Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.

Ropivacaine with Bupivacaine-lidocaine Mixtures used in Peribulbar Blocks for Cataract Surgery: A Randomised, Triple-blind Clinical Study

Introduction: Till recently, for providing anaesthesia for cataract surgeries peribulbar blocks were most commonly employed using various proportions of 0.5% bupivacaine and 2% lidocaine mixtures. As both these anaesthetic agents were reported to produce cardiovascular and Central Nervous System (CNS) side-effects, safer agents like levobupivacaine and ropivacaine are being introduced into clinical practice. Aim: To make a comparative evaluation of the characteristics of peribulbar blocks with 0.75% ropivacaine vis-à-vis the popularly used bupivacaine plus lidocaine mixtures. Materials and Methods: A randomised, triple-blind clinical study was undertaken between August 2021 and December 2021 comparing ropivacaine versus bupivacaine-lidocaine mixtures. A total of 90 patients attending the hospital for cataract surgeries were allocated into three groups of 30 each. Peribulbar blocks were given with 6 mL of 0.75% ropivacaine in group R, 6 mL of 1:1 mixture of 0.5% bupivacaine and 2% lidocaine in group BL, and 6 mL of 1:1 mixture of 0.5% bupivacaine and 2% lidocaine with adrenaline in groups BLA. The primary outcome measure was the total duration of analgesia (pain in the eye of grade >2). The secondary outcome measures studied were the time to onset of the motor and sensory blocks, the total analgesic requirement in the first 24 hours after surgery and changes in the Intra-Ocular Pressures (IOP) after administration of the block. For statistical analysis, Analysis of Variance (ANOVA) and posthoc test of Tukey’s Honestly Significant Difference were used for parametric data and Chi-square test was used for non parametric data and a p-value of 0.05 was considered statistically significant. Results: The demographic characteristics and the baseline vital signs were comparable in all the three groups. Duration of the analgesia of the block was 4.2±0.79 hours, 3.6±1.08 hours, and 3.8±0.55 hours in groups R, BL and BLA, respectively. The total duration of analgesia was significantly longer in group R. The total analgesic consumption was 58.3 ±18.9,75±25.42 and 68.3±24.5 and patients of group R had a significantly decreased consumption. There was a significant reduction in IOP in the patients of group R compared to other groups and the differences observed at 5 minutes,10 minutes and 25 minutes intervals were found to be statistically significant. Burning sensation in the eyes while injecting the drug for the peribulbar block was reported by 2, 10 and 12 patients respectively in groups R, BL and BLA and the patients of group R were found to have less number of burning sensation episodes which was statistically significant (p-value=0.0084). More number of patients and surgeons in groups R had greater satisfaction levels. Conclusion: In peribulbar blocks, 6 mL of 0.75% ropivacaine produces satisfactory block characteristics with prolonged analgesia, reduced IOP, stable haemodynamics and optimal surgical operating conditions and patient satisfaction levels.

Ultrasound-Guided Peribulbar Block with Blunt Canula for Cataract Surgery: A Review of Historical Case-Series

Introduction: Cataract surgery is one of the procedures most performed worldwide. Those are several options for anesthetic management, with many factors that affect the choice of any given technique, depending on patients’ needs, surgeons’ preferences and institutional facilities and processes. Although being more invasive than topic anesthesia, and with possible hazardous side effects, peribulbar block is still an effective and successful technique. The utilization of blunt canula and ultrasound guidance might enhance the safety pattern for this technique. Methods: This article presents a revision of 1089 consecutive cases from February 2016 to January 2022, of patients submitted to cataract surgery under peribulbar anesthesia with blunt canula and ultrasound guidance. Results: 1318 surgical records were selected, with 1089 filling the inclusion criteria. There was a higher prevalence of the feminine gender (54%), with a median age of 64.3 (28 - 102) years. Mean IAV was 2.9 mL (sd 0.16 mL, 2.5 - 3.0 mL), with total HOS 91.1%; OR to reach G2 or above for each (ISB/IMB) was 11.0; CA was 47.9%, with mean FAV of 4.29 mL (sd 2.17mL, 2.5 - 15 mL). In 8.9% patients, HOS could not be fully observed. ISB, IMB, CA and FAV were calculated for both groups (non-HOS and HOS-only). OR for CA (non-HOS/HOS-only) was 126.21. The main adverse effects were chemosis (2.9%), hyposphagma (5.7%) and high IOP (7.5%). No procedure was postponed due to anesthesia-associated adverse events. Discussion: This study points towards the feasibility of the described technique in an outpatient fashion, with low, mild and tolerable side effects associated.

Morphological and Morphometric Analysis of Stylomastoid Foramen in Dry Human Skulls and its Clinical Implications

Introduction: Stylomastoid foramen present between two processes which are styloid process and mastoid process. Facial nerve and stylomastoid arteries are transmitted through the stylomastoid foramen. Facial canal gets terminated in the stylomastoid foramen. Stylomastoid foramen has a site for facial nerve block. Complications reduced by localization of foramen.
 Aim: The aim of this study was to analyse the morphology and morphometry of stylomastoid foramen.
 Materials and Methods: Damaged skulls were excluded and 60 dry human skulls without any damage were taken for this study. By using digital vernier caliper length and breath of the stylomastoid foramen was measured. Then the statistical analysis was done using SPSS software and paired t-tests were done for comparison.
 Results: The length and breadth of the right stylomastoid foramen was 2.39 ± 0.18 mm and 0.85 ± 0.12 mm and the left stylomastoid foramen was 2.18 ±0.33 mm and 1.13 ± 0.38 mm. From the paired t-tests it was very clear that the difference between the breath of right and left stylomastoid foramen was significant (p<0.05) and difference between the length of right and left stylomastoid foramen was not significant (p> 0.05).
 Conclusion: The narrow size of stylomastoid foramen varied from individual skull to other. The accurate value for length and breadth, was measured to determine the variations of facial nerve emerging through it. The change in length and breadth of stylomastoid foramen can be correlated with its clinical aspects with reference to facial nerve.

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.

COMPARISON BETWEEN SILICONE OCULAR IMPLANT AND HYDROXYAPATITE OCULAR IMPLANT FOLLOwING EVISCERATION - MRI STUDY.

Aim : To compare long term outcomes of silicone and hydroxyapatite ocular implant following evisceration using MRI Design: Prospective observational study. Participants: Total twelve patients with the indication of evisceration were admitted from DMCH OPD, Darbhanga, Bihar, between June 2019 to July 2021. Methods: All patients admitted for evisceration were divided in two groups with 6 patients each. Group A patients received silicone ocular implant and group B patients received hydroxyapatite ocular implant following evisceration. Under peribulbar block evisceration was performed with scleral modification including anterior relaxing incision and posterior radial relaxing sclerotomy incisions between the rectus muscles to accommodate a large sphere without tension on the wound. MRI orbit was done after six months. Main outcome measures: It is measured in terms of implant migration, extrusion, socket infection, conjunctival dehiscence and implant exposure, ocular mobility. Result: All patients underwent successful surgery with complications of implant extrusion and socket infection being encountered with silicone implant in one patient out of six while no such complication was seen with hydroxyapatite implant. Ocular motility was maximum with hydroxyapatite compared to silicone implant. MRI study showed higher rate of conjunctival dehiscence for socket with hydroxyapatite implant (4/6) compared to socket with silicone implant1/6. Conclusion: Hydroxyapatite ocular implant tends to have more ocular adhesion property then silicone ocular implant so less chance of extrusion which is also supported by MRI study. Hydroxyapatite orbital implant had good success rate without major complication in comparison to silicone ocular implant.

Comparing General Anesthesia with Preemptive IV Atropine vs General Anesthesia with Single Injection Peribulbar Block with Levobupivacaine 0.5% or Lidocaine 2% for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery: Randomized Control Study

Abstract Background Strabismus is one of the common health problems among the children. The incidence of the oculocardiac reflex decreases with age and tends to be more pronounced in young, healthy patients, which is clinically significant for pediatric as it is observed with greatest incidence in young healthy neonates and infants undergoing strabismus surgery. Objective to prevent and attenuate the oculocardiac reflex in children age group from (2yrs to 14 yrs) undergoing surgical correction for strabismus. Patients and Methods Three groups were allocated Group C received general anaesthesia combined with pre emptive atropine, Group L received general anaesthesia combined with Peribulbar block with Lidocaine 2 % and Group LB which received general anaesthesia combined with peribulbar block with Levobupivacaine 0.5%. Results In Our study we found that group L which received peribulbar lidocaine 2 % was the most successful group regarding blocking the occurrence of the OCR and with acceptable post operative pain control results. Conclusion In Our study the use of peribulbar block with lidocaine 2 % in combinations with General anaesthesia is very effective against the incidence of OCR in children undergoing strabismus surgery and superior to the Iv pre emptive Atropine with higher surgeon satisfaction while the use of peribulbar levobupivacaine 0.5% combined with general anaesthesia has a great role in post operative pain control with superior patient satisfaction, on the other hand the atropine is a very important emergency drug but our study found that it has a very minor role in both preventing the OCR and post operative pain control in addition to subjecting the patients to the tachycardia and other complications like dryness of the mouth and blushing so its not recommended by our study.

Globe luxation after peribulbar block – The untold story of an iatrogenic complication

Globe luxation after peribulbar block – The untold story of an iatrogenic complication

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.

Neuro-Ophthalmological Emergencies. Are They Always Innocent? A Case Report and a Literature Review

Neuro-ophthalmogical complications are rare but can be serious after regional block. We present a case of a 54-year-old diabetic patient who was scheduled for pars plana vitrectomy of his right eye due to tractional retinal detachment, under a peribulbar block with a mixture of lidocaine and ropivacaine. He presented with tachycardia, hypertension, seizures, respiratory distress and apnea. He was intubated for less than 24 hours. He was discharged with no neurological deficit. A review regarding these rare but serious neurological complications of ophthalmic surgery is presented, to raise awareness of neurologists, who are called to evaluate and treat these patients

Minimum effective volume of local anesthetic in peribulbar block: does it differ with the eyeball axial length?

BackgroundPeribulbar Anesthesia (PBA) is a relatively safe method for cataract surgery. The anesthetic volume should be adjusted according to the axial eyeball length. Thus, using Minimum Effective Volume (MEV) of local anesthetic helps avoiding unnecessary volumes, preventing increases in intra-ocular pressure, and producing satisfactory conditions for cataract surgery. This study aims to determine the MEV90 of local anesthetics in relation to eye globe axial length in peribulbar blocks for cataract surgery. MethodsPatients scheduled for cataract extraction under local anesthesia were divided according to their axial eyeball length; Group 1 included those with axial length from 22 to 24 mm, Group 2 included patients with axial length from 24.1 to 26 mm. The initial volume used was 7 mL of a solution of bupivacaine 0.5% (3 mL) + lidocaine 2% (3 mL) + hyaluronidase 150 IU (1 mL). The subsequent volumes were dependent on the response of the previous patient, by using a Bias Coin Design (BCD) and Up and Down Method (UDM) for MEV-90 determination. ResultsThe study was concluded with 119 patients. Sixteen patients needed supplemental volume of local anesthetic in Group 1 and thirteen in Group 2. The MEV90 for Group 1 was approximately 5.82 mL (95% CI 5.6 to 5.87 mL) and 5.45 mL for Group 2 (95% CI 5.38 to 5.91 mL). No major complications were noted. There was a negative correlation between the effective volume of LA and eye globe axial length in both groups (p = 0.001). ConclusionThe MEV90 of local anesthetics for peribulbar block show a strong and inverse correlation with eye globe axial length. This may help achieving an effective block with minimum 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

Perioperative Anxiolytic and Analgesic Effects of Pregabalin in Vitreo-Retinal Surgery: A Randomized, Double-blind Study.

ObjectivesThis study was done to examine the effect of a single, one-time pregabalin dose on postoperative pain, anxiety, and analgesic consumption after vitrectomy performed under the peribulbar block and to assess the satisfaction of the patients as well as the surgeons.MethodsThis randomized, double-blinded, placebo-controlled trial was conducted at Magrabi Eye, ENT and Dental Center, Doha, Qatar on 58 adult patients aged 37 - 75 years, who met status I and II of the American Society of Anesthesiologists (ASA) and scheduled for elective vitrectomy, under the peribulbar block (PB). Of the total participants, 30 cases were randomized to receive pregabalin, while the remaining received placebo 90 minutes before surgery. Pain was assessed using a Verbal Analog Scale (VAS) score, and the levels of anxiety were gauged by verbal anxiety score.ResultsPatients who received pregabalin had a significantly higher sedation score (3 ± 0 vs. & 2 ± 0.65; P < 0.05), and a significantly less anxiety score (3 ± 1.3 vs. 5 ± 1.6; P < 0.001) compared to the control group. During needle insertion for PB, patients in the pregabalin group experienced less pain compared to the control group (32 ± 15 vs. 44 ± 15; P < 0.05). Pregabalin group showed a significantly higher cooperation rate and patient satisfaction scores (3.2 ± 0.7 and 3.8 ± 0.4, respectively), compared to the placebo group (2.8 ± 0.7 and 3.4 ± 0.5, respectively). The placebo group required intraoperative midazolam more in comparison to the pregabalin group (19 vs. 5; P < 0.001). Moreover, the need for postoperative analgesia was more in the placebo group two hours postoperatively.ConclusionsPregabalin is a potent premedication in controlling post-surgical pain and anxiety in patients undergoing vitrectomy under the PB.

Comparison of peribulbar block and subtenon infiltration in pediatric enucleation for retinoblastoma

Purpose:Enucleation performed in children with retinoblastoma is associated with severe postoperative pain. The use of opioids for the pain is associated with numerous complications which demand careful monitoring. Subtenon infiltration and peribulbar block are useful in ameliorating pain perioperatively following various ophthalmic surgeries which are yet to be evaluated in enucleation. Therefore, we designed this study to compare the effects of peribulbar block and subtenon infiltration on postoperative pain with opioids in pediatric enucleation surgeries.Methods:60 children of American Society of Anesthesiologists grade I and II, age ranging from 6 months to 6 years with retinoblastoma undergoing enucleation surgery were included in the study. Group A (n = 20): received peribulbar block (peribulbar group); Group B (n = 20): received subtenon local infiltration (subtenon group); and Group C (n = 20): no block was given.Results:The postoperative fentanyl consumption was lowest with Group B compared to Group A and Group C (P value 0.001). However, the total fentanyl consumption was comparable between groups A and B, while it was significantly higher in the control group. The mean pain score face, legs, activity, cry, consolability (FLACC) scale and mean time to discharge from post anesthesia care unit were lowest in Group B followed by Group A, while Group C had the highest. There was no statistically significant difference among the 3 groups with regards to side effects.Conclusion:Subtenon infiltration showed significantly better outcomes when compared to peribulbar block and intravenous opioids alone without any untoward adverse effects.

Dexamethasone 5 mg Versus Dexmedetomidine 20 μg as Adjuvants to 0.5% Levobupivacaine and 2% Lidocaine for Peribulbar Block Anesthesia

Abstract Background: The addition of adjuvants to local anesthetics in the peribulbar block might be a method to elevate block quality. This study aimed to determine the effectiveness of peribulbar local anesthesia adjuvants using dexmedetomidine 20 mcg and dexamethasone 5 mg. Patients and Methods: This study was a single-blind randomized clinical trial. Patients were divided into three groups who received peribulbar group: Group C (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of normal saline), Group D (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexamethasone 5 mg), and Group M (received 4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexmedetomidine 20 mcg). Sensory and motor block onsets and durations were assessed. Results: There were 42 patients included. The sensory block onset was 70.7 s in Group M and the slowest in Group C (152.1 s). The longest sensory block duration was found in Group D (259.3 min) and the shortest in Group C (143.2 min). Conclusion: Dexamethasone 5 mg adjuvant affected sensory block onset, sensory, and motor block duration but did not affect motor block onset, while dexmedetomidine 20 mcg adjuvant affected sensory and motor block onsets as well as sensory and motor block durations.

English

BACKGROUND Music is an inexpensive, easily available anxiolytic known to mankind since ages. Cataract extraction surgery is one of the widely performed surgeries under local anaesthesia. India is a developing country where limited resources are spent over health infrastructure which has to cater to a large population. In our study we have tried to utilize the anxietolytic effect of music in combating the anxiety and stress patients suffer during surgery. METHODS In this prospective, interventional study, 300 patients diagnosed with senile cataract were selected. The sample size was decided taking into consideration various prevalence studies. The patients were consequently recruited for the study considering the inclusion and exclusion criteria. Patients were divided into three groups - one undergoing phacoemulsification surgery under topical anaesthesia and two groups undergoing phacoemulsification surgery under local anaesthesia by the same surgeon in a same operating room. Two groups including the one where topical anaesthesia was used were made to listen to ‘Classical Sitar Music’ whereas one group was not made to listen to music. Blood pressure and heart rates were measured before and after surgery and compared in all patients. RESULTS Blood pressure and heart rates were statistically significantly normalized (lowered) post-operatively when compared to their pre-operative values in groups which were made to listen to music. There was a marked decrease in the anxiety levels in patients who were operated under topical anaesthesia when compared to those operated under local anaesthesia. CONCLUSIONS Music can be widely used in decreasing anxiety levels in patients undergoing cataract extraction surgery thereby improving the post-operative prognosis in patients in a cost-effective way. KEY WORDS Phacoemulsification Surgery, Classical Sitar Music, Peri-Bulbar Block, Topical Anaesthesia, Anxiety, Blood Pressure, Pulse Rate

Comparative Study between Dexmedetomidine and Midazolam in Inducing Conscious Sedation in Patients Undergoing Cataract Surgery

Background: Cataract surgery are usually done in elderly patients. Dexmedetomidine is a potent non-opiod sedative and analgesic devoid of respiratory depression. Midazolam is the most commonly used sedative which is commonly associated with respiratory depression specially in elderly patients. Objectives: To compare the effects of intravenous dexmedetomidine and midazolam on the haemodynamic stability, sedation and intraocular pressure and to study the safety profile of the drug Methodology: After obtaining permission from institutional ethical committee and patient informed consent, study was conducted at BMCRI from November 2016 to May 2018 in ASA Grade 1 and 2 patients of 40 to 70 year age undergoing cataract surgery. Patients were randomly allocated to two Group D and M of 32 each. Group D received inj. dexmedetomidine 0.25mcg/kg, Group M received inj. midazolam 0.02mg/kg diluted to 10ml over 10 minutes as intravenous injection. Peribulbar block was given with 8-10ml of injection 2% lignocaine with adrenaline with hyaluronidase. Haemodynamic parameters like Heart Rate, Mean Arterial Pressure and SpO2, Intra Ocular Pressure in non-operating eye, Ramsay Sedation Score, Visual Analogue Score and Modified Aldrete Score were recorded. Results: We concluded that in our study demographic data were comparable. Patients of Dexmedetomidine group had reduction of IOP after drug injection (p=0.001) and at post bulbar block (p=0.002) which is statistically significant compared to Group M patients and also there was statistically significant difference in RSS Score between two groups. Conclusions: Dexmedetomidine provides same conscious sedation as Midazolam. Dexmedetomidine reduces intraocular pressure and maintains SpO2 when compared to Midazolam in cataract surgery.

A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer.

This facial and dental regional anesthesia task trainer is designed for teaching emergency medicine (EM) residents and medical students; however, it can be used by other specialties including plastic surgery, otolaryngology, oral surgery, and dentistry. While the opioid epidemic remains a public health crisis, emergency departments (EDs) continue to treat patients who require painful facial procedures or who present with severe dental pain. There is increasing interest and renewed use of regional anesthesia for procedural anesthesia and as an effective non-opioid analgesic. Although many nerve blocks are now being taught using ultrasound guidance, regional anesthesia of the face and mouth is still performed using landmark-based techniques. To date, there are no commercially available task trainers for teaching regional anesthesia of the face and mouth. Therefore, a low-cost, feedback-enhanced, partial task trainer was created for teaching regional anesthesia of the supraorbital, infra-orbital, mental, and inferior alveolar nerves. By the end of this educational session, learners should be able to:Describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves.Successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer. Using inexpensive and commonly found materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. When the needle is inserted in the correct nerve location by the learner, the task trainer provides positive feedback in the form of an audible alert. This innovative task trainer has been used to teach post graduate year (PGY) 1-4 resident learners as part of a standard emergency medicine residency didactics curriculum. After a brief introductory didactic session, participants are given the opportunity for hands-on skills practice using the task trainer under faculty supervision. An existing airway task trainer was successfully modified in order to create a feedback-enhanced, partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer. Twenty-one residents (10 PGY-1, 9 PGY-3, 2 PGY-4) participated in a didactic session and all completed a brief post-session survey. Many participants (N=10, 48%) had never previously performed any of these nerve blocks. On average, participants rated their comfort performing these specific nerve blocks before the session to be 1.96 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort level increased to 3.67 on the same scale. Participants rated the usefulness of the feedback-enhanced task trainer to be a 4.71 on a 5-point scale (where 1=not at all useful and 5=extremely useful). Using inexpensive and commonly available materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching regional anesthesia of the face and mouth. Learners reported that the educational session greatly increased their confidence in performing supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks. Additionally, they found the feedback-enhanced partial task trainer to be extremely helpful for teaching appropriate landmark identification. Our model was successfully used to teach facial and dental nerve block techniques which are able to provide both procedural anesthesia and non-opioid analgesia. Future studies could investigate whether this educational session and model leads to increased competence and/or increased performance of facial nerve blocks in the clinical setting. Nerve blocks, regional anesthesia, dental emergencies, facial trauma.

Peribulbar block with intravenous general anaesthesia in community squint camps

Squint is a common problem affecting about 7% of the population, which can be corrected by various methods like refraction, orthoptics or surgery.1 Surgery involves lengthening and shortening of individual muscles or pair of muscles to achieve cosmetically straightened eyes and binocular vision. If not treated for a long time can lead to amblyopia. However, many misconceptions are prevalent in the general public regarding the treatment modalities. Lack of awareness, surgical facilities, expertise and cost of treatment leaves these patients unattended