Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2016.07.003
Brazilian Journal of Anesthesiology
Clinical Information

Amaurosis and contralateral cranial nerve pairs III and VI paralysis after peribulbar block - Case report

Amaurose e paralisia do III e do VI pares cranianos contralaterais após bloqueio peribulbar - relato de caso

Fábio Caetano Oliveira Leme; Eduardo Toshiyuki Moro; Alexandre Alberto Fontana Ferraz

http://dx.doi.org/10.1016/j.bjane.2016.07.003 Braz J Anesthesiol, vol.68, n3, p.299-302, 2018
PDF English
PDF Português
Downloads: 0
Views: 907

Abstract

Abstract Background and objectives: Peribulbar anesthesia has emerged as a safer option compared with intraconal retrobulbar block. Still, peribulbar anesthesia may not be considered without risk. Numerous complications have been described when performing this technique. This report aims to describe a rare case of amaurosis and contralateral paralysis while attempting to perform a peribulbar anesthesia. Case report: Male patient, 75-year old, physical status ASA II, undergoing cataract surgery by phacoemulsification with intraocular lens implantation. Sedated with fentanyl and midazolam and subjected to peribulbar anesthesia. There were no complications during surgery. After finishing the procedure, the patient reported lack of vision in the contralateral eye. Akinesia of the muscles innervated by the cranial nerve pairs III and VI, ptosis, and medium-sized pupils unresponsive to light stimulus were observed. Four hours after anesthesia, complete recovery of vision and eyelid and eyeball movements was seen in the non-operated eye. Conclusions: During peribulbar anesthesia, structures located in the intraconal space can be accidentally hit leading to complications such as described in the above report. Following the technical guidelines and using appropriate size needles may reduce the risk of such complication, but not completely.

Keywords

Peribulbar anesthesia, Retrobulbar block, Complications, Amaurosis, Paralysis, Contralateral

Resumo

Resumo Justificativa e objetivos: A anestesia peribulbar surgiu como uma opção mais segura quando comparada com o bloqueio retrobulbar intraconal. Ainda assim, a anestesia peribulbar não pode ser considerada isenta de riscos. Inúmeras complicações foram descritas quando da aplicação dessa técnica. O presente relato tem como objetivo descrever um caso raro caracterizado por amaurose e paralisia contralaterais quando da tentativa de se fazer a anestesia peribulbar. Relato de caso: Paciente masculino, 75 anos, estado físico ASA II, submetido à facectomia por facoemulsificação com implante de lente intraocular. Sedado com fentanil e midazolam e submetido a APB. Não houve intercorrências durante a cirurgia. Após o término do procedimento o paciente relatou ausência de visão no olho contralateral. Foram observadas acinesia da musculatura inervada pelo III e VI pares cranianos, ptose palpebral e pupilas de tamanho médio, não responsivas ao estímulo luminoso. Após quatro horas da anestesia, houve recuperação completa da visão, da movimentação das pálpebras e do globo ocular não operado. Conclusões: Durante a APB, estruturas localizadas no espaço intraconal podem ser atingidas acidentalmente levando a complicações como a descrita no relato acima. O respeito às diretrizes técnicas e o uso de agulhas com o tamanho adequado podem reduzir o risco de tal complicação, mas não de forma completa.

Palavras-chave

Anestesia peribulbar, Bloqueio retrobulbar, Complicações, Amaurose, Paralisia, Contralaterais

References

Gillart T, Dualé C, Curt I. Ophthalmic regional anesthesia. Curr Opin Anaesthesiol. 2002;15:503-9.

Ripart J, Lefrant JY, De La Coussaye JE. Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections. Anesthesiology. 2001;94:56-62.

Davis 2nd DB, Mandel MR. Efficacy and complication rate of 16,244 consecutive peribulbar blocks. A prospective multicenter study. J Cataract Refract Surg. 1994;20:327-37.

Carneiro HM, Oliveira B, Ávila MP. Anestesia do tronco encefálico após bloqueio retrobulbar extraconal. É possível evitar? Relato de caso. Rev Bras Anestesiol. 2007;57:391-400.

Krilis M, Zeldovich A, Garrick R. Vision loss and partial third nerve palsy following contralateral peribulbar anesthesia. J Cataract Refract Surg. 2013;39:132-3.

Follette JW, LoCascio JA. Bilateral amaurosis following unilateral retrobulbar block [letter]. Anesthesiology. 1985;63:237-8.

Antoszyk AN, Buckley EG. Contralateral decreased visual acuity and extraocular muscle palsies following retrobulbar anesthesia. Ophthalmology. 1986;93:462-5.

Friedberg HL, Kline Jr. OR. Contralateral amaurosis after retrobulbar injection. Am J Ophthalmol. 1986;101:688-90.

Capote AC, Ureña FJB, Ramos MAF. Contralateral amaurosis and extraocular muscle palsies after retrobulbar injection. Arch Soc Esp Oftalmol. 2006;81:45-8.

Nicoll JM, Acharya PA, Ahlen K. Central nervous system complications after 6000 retrobulbar block. Anesth Analg. 1987;66:1298-302.

Brod RD. Transient central retinal artery occlusion and contralateral amaurosis after retrobulbar anesthetic injection. Ophthalmic Surg. 1989;20:643-6.

Vinerovsky A, Rath EZ, Rehany U. Central retinal artery occlusion after peribulbar anesthesia. J Cataract Refract Surg. 2004;30:913-5.

Nakamura K, Toda H, Kakuyama M. Direct vascular effect of ropivacaine in femoral artery and vein of the dog. Acta Anaesthesiol Scand. 1993;37:269-73.

Ishiyama T, Dohi S, Iida H. The effects of topical and intravenous ropivacaine on canine pial microcirculation. Anesth Analg. 1997;85:75-81.

Katsev DA, Drews RC, Rose BT. An anatomic study of retrobulbar needle path length. Ophthalmology. 1989;96:1221-4.

Van den Berg AA. An audit of peribulbar blockade using 15 mm, 25 mm and 37.5 mm needles, and sub-Tenons injection. Anaesthesia. 2004;59:775-80.

Rubin AP. Complications of local anaesthesia for ophthalmic surgery. Br J Anaesth. 1995;75:93-6.

Mc Goldrick KE, Gayer SI. Anesthesia for ophthalmologic surgery. Clinical anesthesia. 2013:1373-99.

Capó H, Roth E, Johnson T. Vertical strabismus after cataract surgery. Ophthalmology. 1996;103:918.

5dcc376b0e8825211cbf58f2 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections