title: Simulated peribulbar injection of anesthetic.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York.
authors.forename: K
authors.initials: K
authors.lastname: Zahl
authors.forename: J M
authors.initials: JM
authors.lastname: Nassif
authors.forename: M A
authors.initials: MA
authors.lastname: Meltzer
authors.forename: P
authors.initials: P
authors.lastname: Som
mesh_terms: 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
chemical_list: D000777:Anesthetics; D003974:Diatrizoate Meglumine