title: Haemorrhage and risk factors associated with retrobulbar/peribulbar block: a prospective study in 1383 patients.
abstract: Patients undergoing intraocular surgery are elderly and may have disease or be receiving medication which increases the risk of haemorrhage. We interviewed 1383 consecutive patients scheduled for eye surgery requiring retrobulbar/peribulbar block about their use of non-steroidal anti-inflammatory drugs, oral steroids and warfarin. A history of diabetes mellitus and globe axial length was noted. Medial peribulbar and inferolateral retrobulbar blocks were performed by three specialists and six doctors in training. The ensuing haemorrhages were graded as follows: 1 = spot ecchymosis; 2 = lid ecchymosis involving half of the lid surface area or less; 3 = lid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar haemorrhage with increased intraocular pressure. Acetylsalicylic acid was taken by 482 (35%) patients, non-steroidal anti-inflammatory drugs by 260 (19%) and warfarin by 76 (5.5%). Lid haemorrhages (grades 1-3) were observed in 55 patients (4.0%); in 33 of these patients the haemorrhages were spotlike (grade 1). No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or warfarin, whether or not they had been discontinued, did not predispose to haemorrhage associated with retrobulbar/peribulbar block.
authors.affiliation: Department of Anaesthesia, Helsinki University Central Hospital, Helsinki University Eye Hospital, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Kallio
authors.forename: M
authors.initials: M
authors.lastname: Paloheimo
authors.forename: E L
authors.initials: EL
authors.lastname: Maunuksela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D005130:Eye Hemorrhage / Q000209:etiology*; D005141:Eyelid Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D019315:Retrobulbar Hemorrhage / Q000209:etiology*; D012307:Risk Factors; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin