Peribulbar anaesthesia for penetrating keratoplasty. A case series.
OBJECTIVE
To prospectively analyse the efficacy and safety of peribulbar anaesthesia for penetrating keratoplasty through a noncomparative, consecutive series.


METHODS
One hundred twenty-four (91.1%) of 136 patients undergoing penetrating keratoplasty (PK) from January 1997 to December 2001, were administered peribulbar anaesthesia. The anaesthetic mixture consisted 5 ml of lignocaine, bupivacaine, and hyaluronidase (to avoid evaluation bias) in the peribulbar space. A repeat injection of 3 ml was used if the primary injection was inadequate. Digital ocular compression was done for 10-15 minutes after the first injection. Each patient was analysed for degree of akinesia, subjective patient comfort, analgesia, subjective surgeon comfort, and types of surgical conditions.


RESULTS
The age ranged from 19 to 86 years. Forty-nine of 124 patients (39.5%) received PK only and remaining 75 patients (60.5%) received additional procedures. A single injection was sufficient to achieve adequate akinesia (grade II and III) in 114 (92%) patients and 120 (97%) of patients were satisfied (graded pain as < or = grade II). During surgery, 6 (5%) phakic eyes developed episodes of positive intraocular pressure and 5 eyes (4%) developed chemosis. There were no other local or systemic adverse events. The surgeon level comfort was (grade II or more) 98% (122 of 124).


CONCLUSIONS
One-point, low volume, peribulbar anaesthesia for penetrating keratoplasty is safe and efficacions.
Agrawal
Vinay
V
Dept. of Ophthalmology, Clear Vision Eye Center, Bombay, India. agrawals@vsnl.com
Tharoor
Madhusoodan
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007267:Injections; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D009802:Oculomotor Nerve / Q000187:drug effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D012449:Safety
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine