What is peribulbar block?
peribulbar block is use to obtain Anesthesia and akinesia of the eye by injecting a local Anesthesia around the muscle cone.
Anesthetic solution for givig block
1.Lidocain hydrocloride.
2.Bupivacain.
3Hyaluronidase.
Lidocain hydrocloride : Bupivacain +Hyaluronidase = 5:3
Use of pactice, Lidocain Hydrocloride:Bupivacain+ Hyaluronidase =5:1
So,50ml Lidocain hydrocloride 2%+10ml Bupivacain +1500IU Hyaluronidase.
use of block.
Quantity of Anesthetic solution :
For peribulbar block :6-8 cc.
Use of needle of peribulbar block:
1inch or 23 G steel needle or 1/2 inch 26G needle.
Techniques of peribulbar block:
Inferior injection is gigen at the junction of the outer one third & inner two third of the lowe orbital rim.
Or, Superior injection is given usually nassally just above the medial canthus the superior injection may be avoided till the time the inferior injection take effect to judge the necessity for the additional injection.
Or, If good akinesia is attained by the inferior there is no needed for the superior injection. Gently press on the lower lid between the orbital margin and the globe to feel the inferior orbital notch and with the other hand progressively injection 5ml of the anesthetic solution starting solution just under the skin, progressively to just behind the quator of the globe.
Guiding of the needle :
The needle should be slowly advanced, stopping immediately. If there is either a tugging movement of the globe which may indicate sangging of the needle on sclera or an extra ocular muscle.
or, Some ask the patient to look up and down to ensure that the globe has not been impaled other believe that this could cause adjecnt orbital structure to be lacerated over the needle tip.
or,If there is either severe pain or persiatance to injection either of which can indicate injetion into the globe.
Complication of peribulbar block:
1.Venous orbital haemorrhage.
2.Anterior orbital haemorrhage.
3.Allergic reaction.
4.Opthalmophegia direct damage of the EOM(Extra -ocular muscle)
5.Globe perforation.
6.Central sperade of anesthetic life the retina.
7.Optic nerve damage.
Globe perforation:
1.This complication is very rare in experienced hand.
2.More common with the longer eye specifically with stapiloma.
3.If the needle cantes of the sclera, the cornea first moves towards the needle and then suddenly away from it as the needle presses through the sclera.
4.If optain painful, but not always noticed at the time.
5.Surgon might notice the abcence of the red reflex an excessively soft eye or excessively hard eye with coudy cornea if LA has been injected inside the eye.
6.Sometimes the procedure is placid and also the telltale retinal appnrence could also be detected years in a while routine fundoscopy.
7.Rarely enough anaesthesia canbe injected within the attention to cause ocular explosion. this needs IOP of 2800 metric linear unit of hg.
8.Even with immediate recognition the visual prognosis for suchan eye is poor.
How to avoid perforation?
Subtenons block can be used an alternative to peribulbar block as incidence of perforation is minimal.
peribulbar block is use to obtain Anesthesia and akinesia of the eye by injecting a local Anesthesia around the muscle cone.
 |
| Akinesia of globe |
1.Lidocain hydrocloride.
2.Bupivacain.
3Hyaluronidase.
Lidocain hydrocloride : Bupivacain +Hyaluronidase = 5:3
Use of pactice, Lidocain Hydrocloride:Bupivacain+ Hyaluronidase =5:1
So,50ml Lidocain hydrocloride 2%+10ml Bupivacain +1500IU Hyaluronidase.
use of block.
Quantity of Anesthetic solution :
For peribulbar block :6-8 cc.
Use of needle of peribulbar block:
1inch or 23 G steel needle or 1/2 inch 26G needle.
Techniques of peribulbar block:
Inferior injection is gigen at the junction of the outer one third & inner two third of the lowe orbital rim.
Or, Superior injection is given usually nassally just above the medial canthus the superior injection may be avoided till the time the inferior injection take effect to judge the necessity for the additional injection.
Or, If good akinesia is attained by the inferior there is no needed for the superior injection. Gently press on the lower lid between the orbital margin and the globe to feel the inferior orbital notch and with the other hand progressively injection 5ml of the anesthetic solution starting solution just under the skin, progressively to just behind the quator of the globe.
 |
| peribulbar block procedure |
The needle should be slowly advanced, stopping immediately. If there is either a tugging movement of the globe which may indicate sangging of the needle on sclera or an extra ocular muscle.
or, Some ask the patient to look up and down to ensure that the globe has not been impaled other believe that this could cause adjecnt orbital structure to be lacerated over the needle tip.
or,If there is either severe pain or persiatance to injection either of which can indicate injetion into the globe.
 |
| Peribulbar block procedure end |
1.Venous orbital haemorrhage.
2.Anterior orbital haemorrhage.
3.Allergic reaction.
4.Opthalmophegia direct damage of the EOM(Extra -ocular muscle)
5.Globe perforation.
6.Central sperade of anesthetic life the retina.
7.Optic nerve damage.
Globe perforation:
1.This complication is very rare in experienced hand.
2.More common with the longer eye specifically with stapiloma.
3.If the needle cantes of the sclera, the cornea first moves towards the needle and then suddenly away from it as the needle presses through the sclera.
4.If optain painful, but not always noticed at the time.
5.Surgon might notice the abcence of the red reflex an excessively soft eye or excessively hard eye with coudy cornea if LA has been injected inside the eye.
6.Sometimes the procedure is placid and also the telltale retinal appnrence could also be detected years in a while routine fundoscopy.
7.Rarely enough anaesthesia canbe injected within the attention to cause ocular explosion. this needs IOP of 2800 metric linear unit of hg.
8.Even with immediate recognition the visual prognosis for suchan eye is poor.
How to avoid perforation?
Subtenons block can be used an alternative to peribulbar block as incidence of perforation is minimal.
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