Minimum effective volume of local anesthetic in peribulbar block: does it differ with the eyeball axial length?
Peribulbar Anesthesia (PBA) is a relatively safe method for cataract surgery. The anesthetic volume should be adjusted according to the axial eyeball length. Thus, using Minimum Effective Volume (MEV) of local anesthetic helps avoiding unnecessary volumes, preventing increases in intra-ocular pressure, and producing satisfactory conditions for cataract surgery. This study aims to determine the MEV90 of local anesthetics in relation to eye globe axial length in peribulbar blocks for cataract surgery.
Patients scheduled for cataract extraction under local anesthesia were divided according to their axial eyeball length; Group 1 included those with axial length from 22 to 24 mm, Group 2 included patients with axial length from 24.1 to 26 mm. The initial volume used was 7 mL of a solution of bupivacaine 0.5% (3 mL) + lidocaine 2% (3 mL) + hyaluronidase 150 IU (1 mL). The subsequent volumes were dependent on the response of the previous patient, by using a Bias Coin Design (BCD) and Up and Down Method (UDM) for MEV-90 determination.
The study was concluded with 119 patients. Sixteen patients needed supplemental volume of local anesthetic in Group 1 and thirteen in Group 2. The MEV90 for Group 1 was approximately 5.82 mL (95% CI 5.6 to 5.87 mL) and 5.45 mL for Group 2 (95% CI 5.38 to 5.91 mL). No major complications were noted. There was a negative correlation between the effective volume of LA and eye globe axial length in both groups (p = 0.001).
The MEV90 of local anesthetics for peribulbar block show a strong and inverse correlation with eye globe axial length. This may help achieving an effective block with minimum complications.
1 Local anaesthesia for intraocular surgery. The Royal College of Anaesthetists and the Royal College of Ophthalmologists. London. 2001;153:875–881.
2 L. Rizzo, M. Marini, C. Rosati, et al. Peribulbar anesthesia: A percutaneous single injection technique with a small volume of anesthetic Anesth Analg., 100 (2005), pp. 94-96
3 M. Ibrahim, E Gomaa Efficacy of midazolam addition to local anesthetic in peribulbar block Randomized controlled trial Der Anaesthesist., 68 (2019), pp. 143-151
4 H. Kallio, M. Paloheimo, E. Mauniksela Hemorrhage and risk factors associated with retrobulbar/peribulbar block: a prospective study in 1383 patients Br J Anaesth., 85 (2000), pp. 708-711
5 H.E. Schulenburg, C Sri-Chandana, G. Lyons, et al. Hyaluronidase reduces local anesthetic volumes for sub-Tenon’s anesthesia Br J Anesth., 99 (2007), pp. 717-720
6 E. O’Donoghue, M. Batterbury, T. Lavy Effect on intraocular pressure of local anaesthesia in eyes undergoing intraocular surgery Br J Ophthalmol., 78 (1994), pp. 605-607
7 MŠ Kolega, S. Kovačević, S. Čanović, et al. Comparison of IOL – master and ultrasound biometry in preoperative Intra Ocular Lens (IOL) power calculation Coll Antropol., 39 (2015), pp. 233-235
8 Q.H. De Tran, S. Dugani, A. Dyachenko, et al. Minimum effective volume of lidocaine for ultrasound-guided infraclavicular block Reg Anesth Pain Med., 36 (2011), pp. 190-194
9 S.D. Durham, N. Flournoy, W.F. Rosenberger A random walk rule for phase I clinical trials Biometrics., 53 (1997), pp. 745-760
10 Ds Friedman, Sw Reeves, Eb Bass, et al. Patient preferences for anesthesia management during cataract surgery Br J Ophthalmol., 88 (2004), pp. 333-335
11 MD Ahmed Samir, MD. Ahmed Gabal Percaruncular single injection peribulbar anesthesia in patients with axial myopia for phacoemulsification Saudi J Ophthalmol., 26 (2012), pp. 87-90
12 RW Johnson Anatomy for ophthalmic anesthesia Br J Anaesth., 75 (1995), pp. 80-87
13 I. Bekerman, P. Gottlieb, M. Vaiman Variations in eyeball diameters of the healthy adults J Ophthalmol., 2014 (2014), Article 503645
14 R. Goyal, R.V. North, J.E. Morgan Comparison of laser interferometry and ultrasound A‐scan in the measurements of axial length Acta Ophthalmol Scand., 81 (2003), pp. 331-335
15 G.S. Rinkoff, B.H. Doft, L.A. Lobes Management of ocular penetration from injection of local anesthesia preceding cataract surgery Arch Ophthalmol., 109 (1991), pp. 1421-1425
16 LA McGrath, CP Bradshaw Transconjunctival approach to peribulbar block Clin Ophthalmol., 7 (2013), pp. 1073-1076
17 A. Naif, A. Rizwan, A. Medhat, K. Ashbala Randomized controlled trial to evaluate intraocular pressure following sub-Tenon’s local anesthesia for cataract surgery: With and without hyaluronidase added to anesthetic solution Saudi J Anaesth., 51 (2014), pp. 563-566
18 M.W. Frow, J.I. Miranda-Caraballo, T.M. Akhtar Single injection peribulbar anesthesia. Total upper eyelid drop as an end-point marker Anesthesia., 55 (2000), pp. 750-756
19 L.F. Soares, A.C.M. Barros, G.P. Almeida, et al. Minimum anesthetic volumes for extraconal retrobulbar block: comparison between 0.5% racemic bupivacaine, levobupivacaine and enantiomeric mixture s75/r25 bupivacaine Rev Bras Anestesiol., 55 (2005), pp. 263-265
20 E.M. Mostafa, A. Mounir Effect of the volume of anesthetic solutions and patient’s age on the efficacy of retrobulbar anesthesia Delta J Ophthalmol., 19 (2018)
21 J. Ripart, J.Y. Lefrant, J.E. de La Coussaye, et al. Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: Anatomical comparison of extraconal and intraconal injections Anesthesiology., 94 (2001), pp. 56-62
22 J. Cehajic-Kapetanovic, P.N. Bishop, S. Liyanage A novel Ocular Anaesthetic Scoring System, OASS, tool to measure both motor and sensory function following local anaesthesia Br J Ophthalmol., 94 (2010), pp. 26-30
23 B. O’Donnell, G. Iohom An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block Anesthesiology., 111 (2009), pp. 25-29
24 Walid Hamed Nofal, Wail Ahmed Abdelaal, Sanaa M. Elfawal Minimum effective volume of bupivacaine in spinal anesthesia for elective cesarean section. Does it differ with height? A non-randomized parallel study Egyptian J Anaesth., 33 (2017), pp. 67-72
25 A.M. Ghali, A. Hafez Single-injection percutaneous peribulbar anesthesia with a short needle as an alternative to the double-injection technique for cataract extraction Anesth Analg., 110 (2010), pp. 245-247