Peribulbar Anesthesia for Vitreoretinal Surgery

Peribulbar Anesthesia has been described for cataract surgery, glaucoma surgery, and vitreoretinal surgery. It has distinct advantages over traditional retrobulbar anesthesia. These advantages include: decreased risk of retrobulbar hemorrhage and globe perforation, reduced amount of anesthesia, and a more rapid surgical preparatory time. Many vitreoretinal surgeons are hesitant to transition to peribulbar anesthesia due to the potential for ocular movement during surgery. The addition of Wydase to the block virtually eliminates this problem. The following are the steps for the administration of peribulbar anesthesia.

Step 1. Apply topical anesthetic upon entry into the operating room.

Step 2. Traditional betadine preparation of the surgical area and sterile draping of the eye.

Step 3. Apply a cotton-tip soaked in Lidocaine or Tetracaine to the inferonasal conjunctiva (Figure 1).

Figure 1

Step 4. Use a 0.3 forcep and Wescott scissors to dissect through the conjunctiva and Tenon’s capsule (Figure 2).

Figure 2

Step 5. Advance the cannula posteriorly (Figures 2-5).

Figure 3

Figure 4

Figure 5

Step 6. Administer 3 to 5 cc of block. Take care during this portion to monitor the amount of posterior pressure created.

Step 7. Remove the cannula (Figure 6).

Figure 6

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