ISSN 2398-2942      

Local anesthesia: retrobulbar

icanis
Contributor(s):

David Gould

Ralph Hamor


Introduction

  • Retrobulbar injection of local anesthetic desensitizes the structures of the eye and paralyzes the external ocular muscles, providing a globe which is anesthetized and central.

Uses

  • Historically, retrobulbar anesthesia was used as an adjunct for intraocular surgery to produce a centrally-positioned globe, but for this use it has largely been superseded by the use of neuromuscular blocking agents Anesthesia: non-depolarizing neuromuscular blockade.
  • Still occasionally used as adjunctive agent for enucleation surgery Eye: enucleation.

Advantages

  • Provides excellent peri-operative analgesia.

Disadvantages

  • Inadvertent injection of local anesthetic agent into a blood vessel could lead to sudden death.
  • Inadvertent injection of local anesthetic agent into the CSF surrounding the optic nerve could lead to respiratory arrest due to brainstem anesthesia.
  • Risk of globe trauma if performed incorrectly. Prior to enucleation this complication is less of a concern unless endophthalmitis is present, in which case it risks local spread of infection.
  • Risk of trauma to local tissues.
  • Risk of initiation of oculocardiac reflex.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

  • Accola P J, Bentley E, Smith L J et al (2006) Development of a retrobulbar injection technique for ocular surgery and analgesia in dogs. JAVMA 229 (2), 220-225 PubMed.

Other sources of information

  • Robertson S (2002)Anaesthesia and analgesia.In:BSAVA Manual of Small Animal Ophthalmology. 2nd edn. BSAVA Publications, Gloucs. pp 30-35.

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