CASE REPORT OF PERIBULBAR BLOCK ANESTHESIA

FOR EVACUATION SILICON OIL IN RETINAL SURGERY

Jaya Supriyanto1, Dedi Fitri Yadi1, Rakhman Adiwinata2

1
Department of Anesthesiology and Intensive Therapy
Padjadjaran University Faculty Of Medicine — Hasan Sadikin General Hospital, Bandung
2
Cicendo Eye Hospital, Bandung

Background
Ophthalmic surgery is a special procedure and challenging for anesthesiologists, including safety,
akinesia, analgesia, minimal bleeding, obtundation of the oculocardiac reflex, prevention of
intraocular hypertension, awareness of drug interactions, and a smooth emergence devoid of vomiting,
coughing, or retching. The anesthetic procedure in retinal surgery are retrobulbar block and peribulbar
block.

Objective
To report peribulbar block anesthesia for evacuation silicon oil in retinal surgery

Case
58 years old male underwent silicon oil evacuation under peribulbar block anesthesia. Patient
Classified as ASA I. Local anesthetic was injected by using 25G needle 2,5cm at inferolateral site
then using 27G needle 1,5cm another 3cc local anesthetic was injected at medical canthus manually.
Pressure was applied to the eye for 3 minutes and motoric block was visible. Patient undergo surgery
for an hour with stable hemodynamic.

Discussion
Local anesthetic drugs was injected into extraconal compartment of the eyeball that may blocked
cilliary nerve, cranial nerve III and cranial nerve IV but not cranial nerve II. Site of injection are
inferolateral and medial canthus of the eye. Levobupivacaine, bupivacaine and lidocaine or
combination of such drugs used in peribulbar block. Complications that may occur in the peribulbar
block are perforation of eyeball, retrobulbar bleeding, damage to the optic nerve, intra artery
injections, injection of optic nerve fibers, occulocardiac reflex and allergic reactions and toxicities
related to local anesthetic drugs. In which none was noted in the patient

Conclusion
Peribulbar block can safely used in retinal surgery

Keywords
Ophthalmic surgery, regional anesthesia, peribulbar block

Reference
1. Barash, Paul G. Clinical Anesthesia. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott
Williams & Wilkins, 2013
2. Danilo Jankovic Philip Peng: Regional Nerve Blocks In Anesthesia And Pain Therapy, Springer:
Fourth Edition, 2015
3. John F. Butterworth, David C. Mackey, John D. Wasnick, Clinical Anesthesia, Fifth Edition. New
York, 2015. Mc Graw-Hill