Simulated peribulbar injection of anesthetic.
To evaluate whether intracranial spreading of a local anesthetic might occur after a peribulbar injection, we did simulated peribulbar anesthetic injections with radiopaque dye into two cadaver heads. Using a standard and modified peribulbar injection with a 25-gauge needle, the four orbits were injected with 8 mL of dye. Computed tomography revealed that the dye spread intraconally and intracranially. In one case the dye was seen tracking along the optic nerve sheath. Since intracranial spreading of a local anesthetic may be associated with adverse sequelae (i.e., brainstem anesthesia), we urge caution and vigilance after both peribulbar and retrobulbar anesthetic injections to prevent cardiopulmonary compromise.
Zahl
K
K
Department of Anesthesiology, Mount Sinai School of Medicine, New York.
Nassif
J M
JM
Meltzer
M A
MA
Som
P
P
D000777:Anesthetics / Q000493:pharmacokinetics; D003974:Diatrizoate Meglumine / Q000493:pharmacokinetics*; D006801:Humans; D007267:Injections; D008954:Models, Biological; D009900:Optic Nerve / Q000000981:diagnostic imaging; D009915:Orbit / Q000000981:diagnostic imaging / Q000378:metabolism*; D012886:Skull / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D000777:Anesthetics; D003974:Diatrizoate Meglumine