Teaching corner: Regional anaesthesia for ophthalmic surgery

Abstract

Performing safe and effective regional anaesthesia for ophthalmic surgery is an important skill for anaesthetic and ophthalmologic practitioners. Akinetic sharp-needle blocks are generally safe but rare, sight and life threatening complications occur. Sub-Tenon's block using a blunt canula provides akinesa and is a safer alternative but serious complications have been reported. This review provides an introduction to the relevant anatomy, local anaesthetic drugs and commonly used techniques and a practical guide to their safe performance.

Figure 1

Transverse plane of orbital cavities

Figure 2

Structures entering the apex of orbital cavity.

Figure 4

Landmark for inferotemporal injection

Figure 5

Needle direction for infero-temporal injection after lid retraction. Sagittal plane.

Figure 6

Sites of injection for peribulbar block

Figure 7

Site of injection for medial canthal approach

Figure 8

Transverse view of medial canthal approach.

Figure 9

Sub-Tenon's injection. Patient looks out and up. Conjunctiva grabbed 5mm from limbus.

Figure 10

Insert blunt canula into space between Tenon's layer and sclera.