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Hassanin AA, Moharam HEM, Hassan SH, Hashish SA. Fentanyl as an adjuvant to the local anesthetic in the peribulbar block for vitrectomy operations. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2175845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- Abeer A Hassanin
- Anesthesia Department, Ophthalmology Department, Faculty of Medicine, Minia University, Minya, Egypt
| | - Hossam Elden M Moharam
- Anesthesia Department, Ophthalmology Department, Faculty of Medicine, Minia University, Minya, Egypt
| | - Shimaa H Hassan
- Anesthesia Department, Ophthalmology Department, Faculty of Medicine, Minia University, Minya, Egypt
| | - Sahar A Hashish
- Anesthesia Department, Ophthalmology Department, Faculty of Medicine, Minia University, Minya, Egypt
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Osama NA, Mohamed MK, Aboul Fetouh IS, Sherif NA. Ketamine versus midazolam as an adjuvant to peribulbar block using a single inferonasal injection in patients undergoing vitreoretinal surgery: A randomized controlled trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:276-283. [PMID: 36934847 DOI: 10.1016/j.redare.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/13/2022] [Indexed: 04/23/2023]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to assess the safety and efficacy of midazolam and ketamine as adjuvants to the peribulbar block in vitreoretinal surgeries. PATIENTS AND METHODS This 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). RESULTS The 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). CONCLUSIONS Ketamine 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.
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Affiliation(s)
- Noha A Osama
- Department of Anesthesia, Research Institute of Ophthalmology, Giza, Egypt.
| | - Mayada K Mohamed
- Department of Anesthesia, Research Institute of Ophthalmology, Giza, Egypt
| | | | - Norhan A Sherif
- Department of Anesthesia, Research Institute of Ophthalmology, Giza, Egypt
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Kheir TM, Saleh EM, Khattab RS, Naguib NN. Ketamine versus magnesium sulphate as an adjuvant to local anesthetics in the peribulbar block for posterior segment surgeries: a randomized controlled study. Minerva Anestesiol 2021; 88:32-41. [PMID: 34633168 DOI: 10.23736/s0375-9393.21.15730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Tamer M Kheir
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eslam M Saleh
- Anesthesia Department, Research Institute of Ophthalmology, Giza, Egypt -
| | - Rehab S Khattab
- Anesthesia Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Nader N Naguib
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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El Fawal SM, Nofal WH, Sabek EAS, Abdelaal WA. Minimum effective volume of local anesthetic in peribulbar block: does it differ with the eyeball axial length? Braz J Anesthesiol 2021; 71:635-641. [PMID: 34562489 PMCID: PMC9373596 DOI: 10.1016/j.bjane.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Peribulbar 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. Methods Patients 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. Results The 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). Conclusion The 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.
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Affiliation(s)
| | - Walid H Nofal
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Eman A S Sabek
- National Centre of Radiation Research and Technology, Atomic Energy Authority, Cairo, Egypt
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Ahmed SA, Elmawy MG, Awd M. Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: Randomized controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sameh Abdelkhalik Ahmed
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tanta University, Egypt
| | - Mohamad Gamal Elmawy
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tanta University, Egypt
| | - Mohammed Awd
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Elfayoum University, Egypt
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Single-injection peribulbar block combined with general anesthesia in children undergoing ophthalmic surgery: A randomized controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2011.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kannan S. Should single medial canthus injection be the default option for peribulbar blocks? Indian J Anaesth 2018; 62:321-322. [PMID: 29720763 PMCID: PMC5907443 DOI: 10.4103/ija.ija_45_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Messeha MM, Elhesy AE. Comparison of orbital muscle akinesia caused by rocuronium versus hyaluronidase mixed to the local anesthetic in single injection peribulbar block for cataract surgery. Anesth Essays Res 2015; 9:374-8. [PMID: 26712977 PMCID: PMC4683490 DOI: 10.4103/0259-1162.164649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The aim of this study was to compare orbital muscle akinesia caused by rocuronium versus hyaluronidase when mixed with the local anesthetic in single-injection peribulbar anesthesia (PBA). Patients and Methods: Sixty patients were included in the study and subjected to cataract extraction using phacoemulsification technique with intraocular lens implantation. Group I received peribulbar block with 5 ml mixture of 30 IU/ml hyaluronidase and 2% lidocaine. Group II received peribulbar block with 5 ml mixture of rocuronium 5 mg and 2% lidocaine. The onset and duration of akinesia were assessed; the akinesia score at 2, 5, and 10 min was measured after injection. The need for supplementary injection was also recorded. Results and Conclusion: PBA using a mixture of rocuronium and lidocaine provides optimal globe akinesia and faster establishment of suitable conditions to start eye surgery and shortens the block onset time as compared with the addition of hyaluronidase to lidocaine.
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Affiliation(s)
- Medhat M Messeha
- Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospital, Mansoura, Egypt
| | - Abd-Elmonem Elhesy
- Department of Ophthalmology, Faculty of Medicine, Mansoura Ophthalmology Center, Mansoura University, Mansoura, Egypt
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Ascaso FJ, Peligero J, Longás J, Grzybowski A. Regional anesthesia of the eye, orbit, and periocular skin. Clin Dermatol 2015; 33:227-33. [DOI: 10.1016/j.clindermatol.2014.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagatsuma JT, Deschk M, Floriano BP, Ferreira JZ, Fioravanti H, Gasparello IF, Oliva VNLS. Comparison of anesthetic efficacy and adverse effects associated with peribulbar injection of ropivacaine performed with and without ultrasound guidance in dogs. Am J Vet Res 2014; 75:1040-8. [DOI: 10.2460/ajvr.75.12.1040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Local experience with caruncular single injection peribulbar anesthesia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Calvache JA, López H, Castro-Delgado OE. Experiencia local con el uso de punción única peribulbar caruncular para anestesia oftálmica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Local experience with caruncular single injection peribulbar anesthesia☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442010-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shilo‐Benjamini Y, Pascoe PJ, Maggs DJ, Kass PH, Wisner ER. Retrobulbar and peribulbar regional techniques in cats: a preliminary study in cadavers. Vet Anaesth Analg 2013; 40:623-31. [DOI: 10.1111/vaa.12060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/17/2013] [Indexed: 11/29/2022]
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McCloud C, Harrington A, King L. A qualitative study of regional anaesthesia for vitreo-retinal surgery. J Adv Nurs 2013; 70:1094-104. [PMID: 24102774 DOI: 10.1111/jan.12263] [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] [Accepted: 08/24/2013] [Indexed: 11/30/2022]
Abstract
AIM The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery. BACKGROUND Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times; this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited. DESIGN An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics. METHODS Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts. FINDINGS Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block; 'experiencing': the experience of regional ocular anaesthesia; 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored; and 'knowing': when further surgery was required and past experiences were recalled. CONCLUSIONS The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function.
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Affiliation(s)
- Christine McCloud
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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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.
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Affiliation(s)
- Ashraf M Ghali
- Department of Anesthesiology, Magrabi Eye & Ear Hospital, Muscat, Oman
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