Anaesthesia for Ophthalmic Surgery: How "Retro" is the Peribulbar Block?

NCT01258959 | Completed

• 1 other identifier: Retro-Parabulbar
• Study Type: observational
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Ophthalmic surgery on the posterior section of the eye can either be performed under general anaesthesia or under local aneasthesia. The local anaesthesia is performed by injecting local anaesthetics behind the eye. There are two techniques: Either the needle is placed into the muscle cone formed by the four recti muscles - this is called intraconal or retrobulbar block, or the needle is placed outside of the muscle cone - this would be called extraconal or peribulbar. In our hospital the investigators usually perform the peribulbar block since it is easier to perform and has a smaller risk to injure the eye. The investigators however realize that the parabulbar block is sometimes very efficient and sometimes not, thus requiring a second or third injection. Now investigators are able to visualize where the local anaesthetics spreads with the help of ultrasound imaging. The aim of the study is to observe and to describe the incidence of intraconal spread of local anaesthetics when a peribulbar block is performed.

Conditions

Ophthalmic Surgery; Parabulbar Block

Keywords

Ultrasound, retrobulbar, parabulbar, ophthalmic surgery.

Outcome Measures

Primary Outcomes (1)

• Incidence of detectable retrobulbar spread of local anaesthetics during peribulbar injection.

  The outcome measure is the description of the spread of local anesthetics during the injection of the drug via the parabulbar needle.

  At start (During peribulbar injection)

Secondary Outcomes (1)

• Assessment of block quality

  20 Minutes after block

Study Arms (1)

Ophthalmic surgery patients

Patients (men and women) of at least 18 years of age undergoing an ophthalmic procedure on the posterior section of the eye under local anaesthesia, i.e. with a peribulbar block. Inclusion and exclusion criteria for the study are the same as for the peribulbar anaesthesia.

Procedure: Ultrasound detection of local anesthetics spread

Interventions

Ultrasound detection of local anesthetics spread PROCEDURE

During the parabulbar injection the ultrasound operator experienced in ultrasound guided retrobulbar block will assess whether there is spread of local anaesthetic in the central cone just behind the sclera (yes or no). The anaesthesist performing the block will be blinded to the ultrasound visualized spread of local anaesthetic.

Ophthalmic surgery patients

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

100 consecutive patients (men and women) of at least 18 years of age undergoing an ophthalmic procedure on the posterior section of the eye under local anaesthesia, i.e. with a peribulbar block.

You may qualify if:

• informed consent

You may not qualify if:

• coagulation disorder
• INR over 1.5 and/or a platelet count less than 75 X 109/L,
• pathological myopia,
• inability of the patient to lie down for the operation for more than 2 hours
• lack of informed consent.

Sponsors & Collaborators

• Sunnybrook Health Sciences Centre: lead

Study Sites (1)

Sunnybrook Health Science Centres

Toronto, Ontario, M4N 3M5, Canada

Location

Related Publications (3)

• Luyet C, Eichenberger U, Moriggl B, Remonda L, Greif R. Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study. Br J Anaesth. 2008 Dec;101(6):855-9. doi: 10.1093/bja/aen293. Epub 2008 Oct 23.

  PMID: 18948389 BACKGROUND

• Ripart J, Lefrant JY, de La Coussaye JE, Prat-Pradal D, Vivien B, Eledjam JJ. Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections. Anesthesiology. 2001 Jan;94(1):56-62. doi: 10.1097/00000542-200101000-00013.

  PMID: 11135722 BACKGROUND

• Ropo A, Nikki P, Ruusuvaara P, Kivisaari L. Comparison of retrobulbar and periocular injections of lignocaine by computerised tomography. Br J Ophthalmol. 1991 Jul;75(7):417-20. doi: 10.1136/bjo.75.7.417.

  PMID: 1854695 BACKGROUND

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER

Study Record Dates

• First Submitted: December 8, 2010
• First Posted: December 13, 2010
• Study Start: January 1, 2011
• Primary Completion: June 1, 2011
• Study Completion: June 1, 2011
• Last Updated: June 9, 2011

Record last verified: 2010-12

Locations

CA (1)