Localization of local anesthetic solution by magnetic resonance imaging.
OBJECTIVE
The aim of this study was to examine the distribution of local anesthetic solution by magnetic resonance imaging (MRI) after combined peribulbar and retrobulbar, superomedial retrobulbar, and sub-Tenon's injection in relation to clinical akinesia.


METHODS
Randomized clinical trial.


METHODS
Fifteen patients scheduled for cataract surgery, 5 patients in each group.


METHODS
Five patients received combined peribulbar and retrobulbar anesthesia, 5 patients received superomedial retrobulbar injection, and 5 patients had sub-Tenon's injection, all with a combination of bupivacaine 0.75%, lidocaine 2%, and hyaluronidase. The MRI scans were performed before the injection and up to 35 minutes after the injection.


CONCLUSIONS
Reliable anesthesia is achieved using a combined peribulbar and retrobulbar block and a relatively great volume of local anesthetic solution, which spreads throughout the orbit, as evidenced by MRI. After superomedial retrobulbar and sub-Tenon's injection, the local anesthetic solution accumulates behind the globe. Sub-Tenon's injection gives good analgesia and slight akinesia with a very small volume. Superomedial retrobulbar injection and combined peribulbar and retrobulbar block provide a similar degree of exophthalmos, which seems to be the result of the volume injected behind the globe.
Niemi-Murola
Leila
L
Department of Anesthesiology, Eye and ENT Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Krootila
Kari
K
Kivisaari
Riku
R
Kangasmäki
Aki
A
Kivisaari
Leena
L
Maunuksela
Eeva-Liisa
EL
D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000378:metabolism*; D000779:Anesthetics, Local / Q000378:metabolism*; D002045:Bupivacaine / Q000378:metabolism; D002387:Cataract Extraction; D003238:Connective Tissue / Q000378:metabolism; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000378:metabolism; D008012:Lidocaine / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009883:Ophthalmic Solutions / Q000378:metabolism; D009915:Orbit / Q000378:metabolism*
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine