Eye Blocks
Last modified: 16 June 2023, 7:13:45 AM AEST
Gems1 / 6
- Don't forget that IOL operations can be done under LA only
- Surgeon can supplement with lignocaine in the anterior chamber before the viscoelastic (gel-like substance) is injected
- Akinesis is important
- Improves the surgical field
- Can really see the eye move on the microscope screen with poor akinesis
- Tolerance varies with proceduralist
- More important for posterior chamber / retinal surgery = traditionally GA
- Eyelid droop
- a good sign of adequate block
- Eye patch is required because of this
Contraindications to regional2 / 6
- movement disorders
- can tape the head still though
- cooperation
- Down syndrome
- dementia
Peribulbar block solution3 / 6
-
1% ropivacaine
-
hyaluronidase
- 1500 units / vial
- dilute to 10 mL
- take 1 mL = 150 units
- add to 1% ropivacaine
-
final concentration
- ropivacaine ~ 1%
- hyaluronidase 15 units/mL
-
Can also draw up 9.8 mL 1% ropivacaine + 0.2 mL hyalase for easier constitution
-
Recipe
- 0.5% lignocaine
- 0.5% ropivacaine
- ie. 1% lignocaine / 1% ropivacaine into 10 mL syringe
- Add hyalase 30 units/mL
Eye preparation4 / 6
- LA drops
- Amethocaine / tetracaine
- 1/2 strength betadine
Eye Blocks = Improve onset and spread
- Hyaluronidase
- Short-acting LA = lignocaine
- Higher concentration = 2% lignocaine
- Gentle external pressure
- Digital pressure
- Honan balloon limited to 30 mmHg
- will improve spread, reduce chemosis, control bleeding
- Do NOT use
- ocular massage = may ⬆IOP to 400 mmHg
Discharge5 / 6
- RA = Home after 90 mins if haemodynamically stable
- GA = 4 hours