1
|
Ranch K, Chawnani D, Jani H, Acharya D, Patel CA, Jacob S, Babu RJ, Tiwari AK, Al-Tabakha MM, Boddu SHS. An update on the latest strategies in retinal drug delivery. Expert Opin Drug Deliv 2024:1-18. [PMID: 38787783 DOI: 10.1080/17425247.2024.2358886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Retinal drug delivery has witnessed significant advancements in recent years, mainly driven by the prevalence of retinal diseases and the need for more efficient and patient-friendly treatment strategies. AREAS COVERED Advancements in nanotechnology have introduced novel drug delivery platforms to improve bioavailability and provide controlled/targeted delivery to specific retinal layers. This review highlights various treatment options for retinal diseases. Additionally, diverse strategies aimed at enhancing delivery of small molecules and antibodies to the posterior segment such as implants, polymeric nanoparticles, liposomes, niosomes, microneedles, iontophoresis and mixed micelles were emphasized. A comprehensive overview of the special technologies currently under clinical trials or already in the clinic was provided. EXPERT OPINION Ideally, drug delivery system for treating retinal diseases should be less invasive in nature and exhibit sustained release up to several months. Though topical administration in the form of eye drops offers better patient compliance, its clinical utility is limited by nature of the drug. There is a wide range of delivery platforms available, however, it is not easy to modify any single platform to accommodate all types of drugs. Coordinated efforts between ophthalmologists and drug delivery scientists are necessary while developing therapeutic compounds, right from their inception.
Collapse
Affiliation(s)
- Ketan Ranch
- Department of Pharmaceutics, L. M. College of Pharmacy, Ahmedabad, India
| | - Disha Chawnani
- Department of Pharmaceutics, L. M. College of Pharmacy, Ahmedabad, India
| | - Harshilkumar Jani
- Department of Pharmaceutics, L. M. College of Pharmacy, Ahmedabad, India
| | - Devarshi Acharya
- Department of Pharmaceutics, L. M. College of Pharmacy, Ahmedabad, India
| | - Chirag Amrutlal Patel
- Department of Pharmacology & Pharmacy practices, L. M. College of Pharmacy, Ahmedabad, India
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates UAE
| | - R Jayachandra Babu
- Department of Drug Discovery and Development, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Amit K Tiwari
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Moawia M Al-Tabakha
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, UAE
| | - Sai H S Boddu
- Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, UAE
| |
Collapse
|
2
|
Leme FCO, Moro ET, Ferraz AAF. Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block – Case report. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 27554191 PMCID: PMC9391794 DOI: 10.1016/j.bjane.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and objectives Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. Case report Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. Conclusions During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
Collapse
Affiliation(s)
- Fábio Caetano Oliveira Leme
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil.
| | - Eduardo Toshiyuki Moro
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
| | - Alexandre Alberto Fontana Ferraz
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
| |
Collapse
|
3
|
Tolesa K, Gebreal GW. Brainstem Anesthesia after Retrobulbar Block: A Case Report and Review of Literature. Ethiop J Health Sci 2017; 26:589-594. [PMID: 28450776 PMCID: PMC5389080 DOI: 10.4314/ejhs.v26i6.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Retro-bulbar anesthesia is one of the most common regional blocks used for intraocular surgeries. Complications associated with regional blocks may be limited to the eye or may be systemic. Case Report After a retro-bulbar block for glaucoma surgery, a 60-year-old man developed loss of consciousness, apnea with hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem as well as a review of the literature on reported cases. Conclusion Although it is rare, treating physicians should be aware of the potentially lethal consequences of retro-bulbar block, understand measures to reduce the risks and early recognition and treatment. Facilities where ophthalmic surgeries are performed under local anesthesia should be properly equipped and staffed for advanced resuscitation.
Collapse
Affiliation(s)
- Kumale Tolesa
- Department of Ophthalmology, Jimma University, Ethiopia
| | - Girum W Gebreal
- Department of Ophthalmology, St Paul's Hospital Millennium Medical College, Ethiopia
| |
Collapse
|
4
|
Al-Motowa S, Ahmad N, Khandekar R, Zahoor A. Comparison of Olive Tipped and Conventional Steven's Cannula for Sub-Tenon Ophthalmic Anesthesia. Middle East Afr J Ophthalmol 2016; 23:307-310. [PMID: 27994394 PMCID: PMC5141624 DOI: 10.4103/0974-9233.194080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE: To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery. METHODS: This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant. RESULTS: There were sixty patients in each group. The age between groups was not statistically different (P = 0.4). The body mass index was higher in the ST group compared to the OT group (P < 0.001). The akinesia score at 5 and 10 min did not differ between groups (P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups (P = 0.1 and P = 0.06, respectively). There were six patients with mild chemosis and redness in the OT group and 15 patients in the ST group. CONCLUSION: An OT cannula is equally effective as the conventional Steven's cannula for delivering STB anesthesia before cataract surgery.
Collapse
Affiliation(s)
- Saeed Al-Motowa
- Department of Outreach and Eligibility, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nauman Ahmad
- Department of Anesthesia, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdul Zahoor
- Department of Anesthesia, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Leme FCO, Moro ET, Ferraz AAF. [Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block - case report]. Rev Bras Anestesiol 2016; 68:299-302. [PMID: 27554191 DOI: 10.1016/j.bjan.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. CASE REPORT Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. CONCLUSIONS During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.
Collapse
Affiliation(s)
- Fábio Caetano Oliveira Leme
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil.
| | - Eduardo Toshiyuki Moro
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
| | - Alexandre Alberto Fontana Ferraz
- Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde, Departamento de Cirurgia, Sorocaba, SP, Brasil
| |
Collapse
|
6
|
Najman IE, Ferreira JZ, Abimussi CJX, Floriano BP, Meneghetti TM, Oliva VNLS, do Nascimento P. Ultrasound-assisted periconal ocular blockade in rabbits. Vet Anaesth Analg 2015; 42:433-41. [DOI: 10.1111/vaa.12237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 08/21/2014] [Indexed: 11/30/2022]
|
7
|
Najman IE, Meirelles R, Ramos LB, Guimarães TCF, do Nascimento P. A randomised controlled trial of periconal eye blockade with or without ultrasound guidance. Anaesthesia 2015; 70:571-6. [DOI: 10.1111/anae.12976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- I. E. Najman
- Department of Anaesthesiology; Botucatu School of Medicine; UNESP; São Paulo Brazil
- Benjamin Constant Institute for the Blind; Rio de Janeiro Brazil
| | - R. Meirelles
- Benjamin Constant Institute for the Blind; Rio de Janeiro Brazil
| | - L. B. Ramos
- Benjamin Constant Institute for the Blind; Rio de Janeiro Brazil
| | - T. C. F. Guimarães
- Research Department of Organ Transplantations; Secretariat of Health; Rio de Janeiro Brazil
| | - P. do Nascimento
- Department of Anaesthesiology; Botucatu School of Medicine; UNESP; São Paulo Brazil
| |
Collapse
|
8
|
ElKhamary SM, Riad W. Three dimensional MRI study: Safety of short versus long needle peribulbar anesthesia. Saudi J Ophthalmol 2014; 28:220-4. [PMID: 25278801 DOI: 10.1016/j.sjopt.2014.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 02/23/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The standard technique of Peribulbar block is to use 25 g 25 mm needle at the junction between the lateral one third and medial two third of the lower orbital rim in the infero-temporal quadrant of the orbit. Theoretically, insertion of longer needles increases the potential of injury to important structure; however, safety of the shorter needle had never been demonstrated. This study describes the anatomy of the orbital structures with magnetic resonance imaging (MRI) using the three-dimensional constructive interference in steady state (3D CISS) sequence to present a morphological basis for needle entry at 12.5 and 25 mm lengths. Statistical comparisons were performed at the 12.5 versus 25 mm depths. Statistical significance was indicated by P < 0.05. METHOD Fifty patients free of orbital pathology with normal axial length were selected for MRI with the 3D CISS sequence. Original axial and multiplanar image reconstruction (MPR) images were selected for image interpretation. Orbital structures were identified at 12.5 and 25 mm depths from the orbital rim to compare significant differences in anatomy between the two imaging planes at the expected needle depth and to assess the size of the globe and the orbit. RESULTS The cross sectional area of the extraocular muscles were statistically significantly smaller at the 12.5 mm plane (P = 0.001). The area of inferotemporal fat was statistically significantly larger at the 12.5 mm plane (P = 0.033). There was no statistical difference in the inferonasal and superonasal fat areas at different depths (P = 0.34, P = 0.35 respectively). The size of the orbit and globe was significantly larger at 12.5 mm (P = 0.001). There was no difference between depths in the presence or absence of neurovascular bundles and supporting structures including the intramuscular septae. CONCLUSION There is a larger structure-free space at a depth of 12.5 mm than at 25 mm. Therefore, the inference is that a needle inserted in the infero-temporal zone to a depth of 12.5 mm is less likely to injure the eyeball or extra-ocular muscles than one advanced to 25 mm.
Collapse
Affiliation(s)
- Sahar M ElKhamary
- Department of Radiology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia ; Mansoura Faculty of Medicine, Diagnostic Radiology Department, Egypt
| | - Waleed Riad
- Department of Anesthesia, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| |
Collapse
|
9
|
Brainstem anaesthesia revisited: Mechanism, presentation and management. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
10
|
Ghali AM, Mahfouz A, Hafez A. Single-injection percutaneous peribulbar anesthesia with a short needle versus sub-Tenon's anesthesia for cataract extraction. Saudi J Anaesth 2011; 5:138-41. [PMID: 21804792 PMCID: PMC3139304 DOI: 10.4103/1658-354x.82780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: This study compared the efficacy of single-injection percutaneous peribulbar anesthesia (PBA) with a short needle with sub-Tenon's anesthesia (STA) to produce optimal operating conditions for cataract extraction in patients with complicated cataract. Methods: Two hundred patients with complicated cataract were enrolled in this prospective, double-blinded, randomized study. Adequate akinesia was a surgical requisite for all cases included in the study because of the expected difficult surgery. The patients were divided into two equal groups to receive either peribulbar anesthesia (PBA) with a 16-mm needle or sub-Tenon's anesthesia. Surgical akinesia (as a primary end point), analgesia, incidence of complications, as well as patient and surgeon satisfaction (as secondary end points) were assessed. Results: Both techniques provided similar analgesia during the operation and similar rates of incidence of chemosis with no serious complications; while the PBA group provided higher degree of akinesia 10 minutes after injection of the local anesthetic, a lower incidence of subconjunctival hemorrhage (SCH) and higher patient and surgeon satisfaction compared to the STA group. Conclusion: We concluded that when globe akinesia is necessary during surgery, the single-injection technique for percutaneous peribulbar anesthesia with a short needle proved to be more suitable than the STA in providing akinesia for cataract surgery. Also, this PBA technique demonstrated a lower incidence of SCH and was preferred to STA by the patients and surgeon.
Collapse
Affiliation(s)
- Ashraf M Ghali
- Department of Anesthesiology, Magrabi Eye & Ear Hospital, Muscat, Oman
| | | | | |
Collapse
|
11
|
Riad W, Abboud E, Al-Harthi E, Kahtani E, Ahmed N. Superficial extraconal blockade for vitreoretinal surgery. Saudi J Anaesth 2010; 4:174-7. [PMID: 21189855 PMCID: PMC2980664 DOI: 10.4103/1658-354x.71346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Context: Needle length plays an important role for the success of ophthalmic block. The standard practice is to use 25 mm needles length; however, unnecessarily long needles may increase the risk of complications especially in the presence of staphyloma or previous scleral buckle. Aims: This work was designed to compare the efficacy of using 15 and 25 mm needle in performing extraconal block for patients undergoing vitreoretinal surgery. Settings and Design: Prospective randomized double blinded study. Materials and Methods: A total of 120 patients were enrolled in this study and were divided in two groups. In group (1) extraconal block was performed using 25 mm needle, while in group (2) 15 mm needle was used. After primary injection, assessment of the block was done by an anesthesiologist who was unaware of the needle used. If satisfactory akinesia was not achieved a supplementation was provided. At the end of the procedures, patients and surgeons were asked to assess their pain and satisfaction with the anesthetic technique. Statistical Analysis used: The sample size calculation using N-Quary version 4. Numerical and categorical data were analyzed using an independent sample, a two-tailed t-test, and chi-square test, respectively. Results: The volume of primary injectable was significantly higher in group 2. The two groups were comparable as regards total volume of local anesthetic, supplementation rate, akinesia, pain score, and surgeon satisfaction. Conclusions: Using 15 mm needle length to perform extraconal blockade for posterior segment procedures is equally effective to 25 mm needle.
Collapse
Affiliation(s)
- W Riad
- Department of Anesthesiology King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | |
Collapse
|
12
|
Malik A, Fletcher EC, Chong V, Dasan J. Local anesthesia for cataract surgery. J Cataract Refract Surg 2010; 36:133-52. [PMID: 20117717 DOI: 10.1016/j.jcrs.2009.10.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 09/29/2009] [Accepted: 10/01/2009] [Indexed: 11/17/2022]
Abstract
Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.
Collapse
Affiliation(s)
- Adeela Malik
- Department of Ophthalmology, Epsom & St. Helier University Hospitals, Carshalton, United Kingdom.
| | | | | | | |
Collapse
|
13
|
Riad W, Ahmed N. Single Injection Peribulbar Anesthesia with a Short Needle Combined with Digital Compression. Anesth Analg 2008; 107:1751-3. [PMID: 18931243 DOI: 10.1213/ane.0b013e3181864d1c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
14
|
Abstract
Research into treatment modalities affecting vision is rapidly progressing due to the high incidence of diseases such as diabetic macular edema, proliferative vitreoretinopathy, wet and dry age-related macular degeneration and cytomegalovirus retinitis. The unique anatomy and physiology of eye offers many challenges to developing effective retinal drug delivery systems. Historically, drugs have been administered to the eye as liquid drops instilled in the cul-de-sac. However retinal drug delivery is a challenging area. The transport of molecules between the vitreous/retina and systemic circulation is restricted by the blood-retinal barrier, which is made up of retinal pigment epithelium and endothelial cells of the retinal blood vessels. An increase in the understanding of drug absorption mechanisms into the retina from local and systemic administration has led to the development of various drug delivery systems, such as biodegradable and non-biodegradable implants, microspheres, nanoparticles and liposomes, gels and transporter-targeted prodrugs. Such diversity in approaches is an indication that there is still a need for an optimized noninvasive or minimally invasive drug delivery system to the eye. A number of large molecular weight compounds (i.e., oligonucleotides, RNA aptamers, peptides and monoclonal antibodies) have been and continue to be introduced as new therapeutic entities. However, for high molecular weight polar compounds the mechanism of epithelial transport is primarily through the tight junctions in the retinal pigment epithelium, as these agents undergo limited transcellular diffusion. Delivery and administration of these new drugs in a safe and effective manner is still a major challenge facing pharmaceutical scientists. In this review article, the authors discuss various drug delivery strategies, devices and challenges associated with drug delivery to the retina.
Collapse
Affiliation(s)
- Kumar G Janoria
- University of Missouri-Kansas City, Department of Pharmaceutical Sciences, School of Pharmacy, 5005 Rockhill Road, Kansas City, MO 64110, USA
| | | | | | | |
Collapse
|
15
|
Kumar CM, Dowd TC. Complications of ophthalmic regional blocks: their treatment and prevention. Ophthalmologica 2006; 220:73-82. [PMID: 16491028 DOI: 10.1159/000090570] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 06/03/2005] [Indexed: 11/19/2022]
Abstract
Complications following ophthalmic regional anaesthesia are rare but are reported during both needle (intraconal and extraconal blocks) and blunt cannula (sub-Tenon's block) techniques. At present there is no perfect technique of ophthalmic regional anaesthesia. This article reports on the complications, treatment and prevention of commonly used ophthalmic regional blocks. Thorough knowledge of the measures required to deal with complications when they occur are of paramount importance for safe clinical practice.
Collapse
Affiliation(s)
- Chandra M Kumar
- Academic Department of Anaesthesia, The James Cook University Hospital, Middlesbrough TS4 3BW, UK.
| | | |
Collapse
|
16
|
Medial Canthus Single-Injection Peribulbar Anesthesia. Reg Anesth Pain Med 2005. [DOI: 10.1097/00115550-200505000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|