title: [Extraconal block for cataract extraction surgery with implantation of intraocular lens: influence of access way (upper or lower) in anesthetic outcome].
abstract: OBJECTIVE
  There is no completely safe anesthetic technique for ophthalmic surgery. The introduction of extraconal anesthesia has increased the number of ophthalmic surgeries with blockade since the incidence of severe complications is lower, as reported by Hay in 1991. Extraconal blockades may be induced by several access ways, among them upper and lower ways. This study aimed at evaluating the influence access ways (upper or lower) in anesthetic outcome.
  
  
  METHODS
  Participated in this study 164 patients of both genders, aged 23 to 92 years, physical status ASA I to IV, 1 and 2 Goldmans cardiac risk index, undergoing elective cataract extraction surgery with intraocular lens implantation. Patients were randomly distributed in two groups of 82 according to primary extraconal block access way: group UE (upper extraconal), group LE (lower extraconal). Blockade quality was evaluated by the following parameters: intraoperative pain, eyelid and/or eyeball movement, persistence of Bell s reflex, number of blocks needed for eye akinesia, and surgeons evaluation.
  
  
  RESULTS
  Upper extraconal approach was associated to more effective eyelid (upper access - 56.1%; lower access 36.6%) and superior rectus muscle akinesia (upper access - 93.9%; lower access 65.9%) and also a lower incidence of supplementary blocks (upper access - 29.3%; lower access 42.7%). The lower extraconal approach was associated to more effective inferior rectus muscle akinesia (upper access - 72%; lower access - 84.1%), however without statistical differences.
  
  
  CONCLUSIONS
  In the conditions of this study the upper extraconal approach was better as compared to the lower approach as the primary access way for anesthetic block for cataract extraction with intraocular lens implantation.
authors.affiliation: Hospital Santa Cruz, Hospital Universitário da Universidade de São Paulo, Brazil. espada@ajato.com.br
authors.forename: Daniel Espada
authors.initials: DE
authors.lastname: Lahoz
authors.forename: Eloisa Bonetti
authors.initials: EB
authors.lastname: Espada
authors.forename: José Carlos Almeida
authors.initials: JC
authors.lastname: Carvalho