Hostname: page-component-f554764f5-nqxm9 Total loading time: 0 Render date: 2025-04-21T14:59:43.152Z Has data issue: false hasContentIssue false
  • English
  • Français

A review of sub-Tenon's block: current practice and recent development

Published online by Cambridge University Press:  28 July 2005

C. M. Kumar ,
S. Williamson  and
B. Manickam
C. M. Kumar
Affiliation:
The James Cook University Hospital, Department of Anaesthesia, Middlesbrough, UK
S. Williamson
Affiliation:
The James Cook University Hospital, Department of Anaesthesia, Middlesbrough, UK
B. Manickam
Affiliation:
The James Cook University Hospital, Department of Anaesthesia, Middlesbrough, UK
Get access

Extract

Summary

The place of sub-Tenon's block in ophthalmic surgery is now established. This block was introduced into clinical practice in the early 1990s as a simple, safe and effective technique. Since then, techniques have evolved, newer cannulae have been introduced and many complications, both minor as well as major, have been reported. This review deals with the recent developments in sub-Tenon's block.

Keywords

ANAESTHESIA LOCALANAESTHESIA OPHTHALMIC, sub-Tenon's block, techniques, complications
Type
Review
Information
European Journal of Anaesthesiology , Volume 22 , Issue 8 , August 2005 , pp. 567 - 577
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Norregaard JC, Schein OD, Bellan L et al. International variation in anesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study. Arch Ophthalmol 1997; 115: 1304–1308.Google Scholar
Hansen TE. Current trends in cataract surgery in Denmark – 1998 survey. Acta Ophthalmol Scand 1999; 77: 685–689.Google Scholar
Eke T, Thompson JR. The national survey of local anaesthesia for ocular surgery. I. Survey methodology and current practice. Eye 1999; 13: 189–195.Google Scholar
Eke T, Thompson JR. The national survey of local anaesthesia for ocular surgery. II. Safety profiles of local anaesthesia techniques. Eye 1999; 13: 196–204.Google Scholar
Leaming DV. Practice styles and preferences of ASCRS members – 2003 survey. J Cataract Refract Surg 2004; 30: 892–900.Google Scholar
Rubin AP. Complications of local anaesthesia for ophthalmic surgery. Br J Anaesth 1995; 75: 93–96.Google Scholar
Hamilton RC. Complications of ophthalmic anesthesia. Ophthalmol Clin North Am 1998; 11: 99–114.Google Scholar
Roman SJ, Chong Sit DA, Boureau CM, Auclin FX, Ullern MM. Sub-Tenon's anaesthesia: an efficient and safe technique. Br J Ophthalmol 1997; 81: 673–676.Google Scholar
Elder M, Leaming D. The New Zealand cataract and refractive surgery survey 2001. Clin Exp Ophthalmol 2003; 31: 114–120.Google Scholar
Hansen TE. Current trends in cataract surgery in Denmark – 1998 survey. Acta Ophthalmol Scand 1999; 77: 685–689.Google Scholar
Eke T, Thompson JR. Safety of local anaesthesia for cataract surgery: why we should look again. Eye 2003; 17: 127–128.Google Scholar
Turnbull CS. The hydrochlorate of cocaine, a judicious opinion of its merits. Med Surg Rep 1884; 29: 628–629.Google Scholar
Swan KC. New drugs and techniques for ocular anesthesia. Trans Am Acad Ophthalmol Otolaryngol 1956; 60: 368.Google Scholar
Mein CE, Woodcock MG. Local anesthesia for vitreoretinal surgery. Retina 1990; 10: 47–49.Google Scholar
Hansen E, Mein C, Mazzoli R. Ocular anaesthesia for cataract surgery: a direct sub-Tenon's approach. Ophth Surg 1990; 21: 696–699.Google Scholar
Stevens JD. A new local anesthesia technique for cataract extraction by one quadrant sub-Tenon's infiltration. Br J Ophthalmol 1992; 76: 670–674.Google Scholar
Greenbaum S. Parabulbar anesthesia. Am J Ophthalmol 1992; 114: 776.Google Scholar
Fukasaku H, Marron JA. Sub-Tenon's pinpoint anesthesia. J Cataract Refract Surg 1994; 20: 468–471.Google Scholar
Ripart J, Metge L, Prat-Pradal D, Lopez FM, Eledjam JJ. Medial canthus single-injection episcleral (sub-tenon anesthesia): computed tomography imaging. Anesth Analg 1998; 87: 42–45.Google Scholar
Bron AJ, Tripathi R, Tripathi B. Wolf's Anatomy of the Eye and Orbit, 8th edn. London: Chapman and Hall, 1997.
Standring S, Ellis H, Healy J, Johnson D, Williams A. Gray's Anatomy: The Anatomical Basis of Medicine and Surgery, 39th edn. Harlow: Churchill Livingstone, 2004.
Local Anaesthesia for Intraocular Surgery: The Royal College of Anaesthetists and The Royal College of Ophthalmologists 2001.
Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment: Number 16: Anaesthesia Management During Cataract Surgery. Accessed from http://www.ahcpr.gov/clinic/epcsums/anestsum.htm on 18 November 2004.
Steeds C, Mather SJ. Fasting regimens for regional ophthalmic anaesthesia. A survey of members of the British Ophthalmic Anaesthesia Society. Anaesthesia 2001; 56: 638–642.Google Scholar
Konstantatos A. Anticoagulation and cataract surgery: a review of the current literature. Anaesth Intens Care 2001; 29: 11–18.Google Scholar
Katz J, Feldman MA, Bass EB et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 2003; 110: 2309.Google Scholar
Sidery M, Absalom A, Burton R. Sub-Tenon's block: are fasting and intravenous access necessary? Br J Anaesth 2004; 92: 909; author reply 909.Google Scholar
Kumar CM, Dodds C, Fanning GL. Ophthalmic Anaesthesia. The Netherlands: Swets and Zeitlinger, 2002.
Verghese I, Sivraj P, Lai YK. The effectiveness of sub-Tenon's infiltration of local anaesthesia for cataract surgery. Aust New Zeal J Ophthalmol 1996; 24: 117–120.Google Scholar
Bergman L, Berglin L, Algvere PV, Laurell CG, Stenkula S. Limbal sub-Tenon's administration of retrobulbar anesthesia using a blunt irrigating cannula. Ophthalmic Surg Lasers 1996; 27: 106–112.Google Scholar
Kumar CM, Williamson S, Chabria R. A simple method of sub-Tenon anaesthesia delivery. Anaesthesia 2000; 55: 612–613.Google Scholar
Kumar CM, Dodds C. A disposable plastic sub-Tenon cannula. Anaesthesia 2001; 56: 399–400.Google Scholar
McNeela BJ, Kumar CM. Sub-Tenon's block with an ultrashort cannula. J Cataract Refract Surg 2004; 30: 858–862.Google Scholar
Behndig A. Sub-Tenon's anesthesia with a retained catheter in ocular surgery of longer duration. J Cataract Refract Surg 1998; 24: 1307–1309.Google Scholar
Rous SM. Simplified sub-Tenon's anesthesia: miniblock with maxiblock effect. J Cataract Refract Surg 1999; 25: 10–15.Google Scholar
McLure HA, Rubin AP. Review of local anaesthetic agents. Minerva Anesthesiol 2005; 71: 59–74.Google Scholar
Moharib MM, Anaesth M, Mitra S. Alkalinized lidocaine and bupivacaine with hyaluronidase for sub-Tenon's ophthalmic block. Region Anesth Pain Med 2000; 25: 514–517.Google Scholar
Ripart J, Lefrant JY, L'Hermite J et al. Caruncle single injection episcleral (sub-tenon) anesthesia for cataract surgery: mepivacaine versus a lidocaine-bupivacaine mixture. Anesth Analg 2000; 91: 107–109.Google Scholar
Gouws P, Galloway P, Jacob J, English W, Allman KG. Comparison of articaine and bupivacaine/lidocaine for sub-Tenon's anaesthesia in cataract extraction. Br J Anaesth 2004; 92: 228–230.Google Scholar
Calenda E, Olle P, Muraine M, Brasseur G. Peribulbar anesthesia and sub-Tenon injection for vitreoretinal surgery: 300 cases. Acta Ophthalmol Scand 2000; 78: 196–199.Google Scholar
Manners TD, Burton RL. Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery. Eye 1996; 10: 367–370.Google Scholar
Li HK, Abouleish A, Grady J, Groeschel W, Gill KS. Sub-Tenon's injection for local anesthesia in posterior segment surgery. Ophthalmology 2000; 107: 41–46.Google Scholar
Tokuda Y, Oshika T, Amano S, Yoshitomi F, Inouye J. Anesthetic dose and analgesic effects of sub-Tenon's anesthesia. J Cataract Refract Surg 1999; 25: 1250–1253.Google Scholar
Kumar CM, Dodds C. Evaluation of Greenbaum sub-Tenon's block. Br J Anaesth 2001; 87: 631–633.Google Scholar
Buys YM, Trope GE. Prospective study of sub-Tenon's versus retrobulbar anaesthesia for inpatient and day-surgery trabeculectomy. Ophthalmolgy 1993; 100: 1585–1589.Google Scholar
Guise P, Laurent S. Sub-tenon's block: the effect of hyaluronidase on speed of onset and block quality. Anaesth Intens Care 1999; 27: 179–181.Google Scholar
Rowley SA, Hale JE, Finlay RD. Sub-Tenon's local anaesthesia: the effect of hyaluronidase. Br J Ophthalmol 2000; 84: 435–436.Google Scholar
British National Formulary. A joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain, London, 2002.
Radhakrishna S, Shekawat F, Furlong G. Sub-Tenon's block without hyaluronidase. Anaesthesia 2004; 59: 411.Google Scholar
Agrawal A, McLure HA, Dabbs TR. Allergic reaction to hyaluronidase after a peribulbar injection. Anaesthesia 2003; 58: 493–494.Google Scholar
Kumar CM, Dowd TC, Dodds C, Boyce R. Orbital swelling following peribulbar and sub-Tenon's anaesthesia. Eye 2004; 18: 418–420.Google Scholar
Kempeneers A, Dralands L, Ceuppens J. Hyaluronidase induced orbital pseudotumour as a complication of retrobulbar anesthesia. Bull Soc Belge Ophthalmol 1992; 243: 159–166.Google Scholar
Zahl K, Jordan A, Soresen B, Gotta A. pH-adjusted lidocaine/bupivacaine mixture are superior for peribulbar block. Anesthesiology 1988; 69: A368.Google Scholar
Zahl K, Jordan A, McGroarty J, Gotta A. pH-adjusted bupivacaine and hyaluronidase for peribulbar block. Anesthesiology 1990; 72: 230–232.Google Scholar
Moharib MM, Anaesth M, Mitra S. Alkalinized lidocaine and bupivacaine with hyaluronidase for sub-Tenon's ophthalmic block. Region Anesth Pain Med 2000; 25: 514–517.Google Scholar
Madan R, Bharti N, Shende D, Khokhar SK, Kaul HL. A dose response study of clonidine with local anesthetic mixture for peribulbar block: a comparison of three doses. Anesth Analg 2001; 93: 1593–1597.Google Scholar
Reah G, Bodenham AR, Braithwaite P, Esmond J, Menage MJ. Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium. Anaesthesia 1998; 53: 551–554.Google Scholar
Kucukyavuz Z, Arici MK. Effects of atracurium added to local anesthetics on akinesia in peribulbar block. Reg Anesth Pain Med 2002; 27: 487–490.Google Scholar
Fukasaku H. Sub-Tenon's pinpoint anesthesia. Ophthalmol Clin North Am 1998; 11: 127–129.Google Scholar
Winder S, Walker SB, Atta HR. Ultrasonic localization of anesthetic fluid in sub-Tenon's, peribulbar, and retrobulbar techniques. J Cataract Refract Surg 1999; 25: 56–59.Google Scholar
Kumar CM, McNeela BJ. Ultrasonic localization of anaesthetic fluid using sub-Tenon's cannulae of three different lengths. Eye 2003; 17: 1003–1007.Google Scholar
Niemi-Murola L, Krootila K, Kivisaari R, Kangasmaki A, Kivisaari L, Maunuksela EL. Localization of local anesthetic solution by magnetic resonance imaging. Ophthalmology 2004; 111: 342–347.Google Scholar
Guise PA. Sub-Tenon anesthesia: a prospective study of 6,000 blocks. Anesthesiology 2003; 98: 964–968.Google Scholar
Kumar CM, Dodds C, McLure H, Chabria R. A comparison of three sub-Tenon's cannulae. Eye 2004; 18: 873–876.Google Scholar
Spierer A, Schwalb E. Superior oblique muscle paresis after sub-Tenon's anesthesia for cataract surgery. J Cataract Refract Surg 1999; 25: 144–145.Google Scholar
Olitsky SE, Juneja RG. Orbital haemorrhage after the administration of sub-Tenon's infusion anaesthesia. Ophthalmic Surg Lasers 1997; 28: 145–146.Google Scholar
Rahman I, Ataullah S. Retrobulbar hemorrhage after sub-Tenon's anesthesia. J Cataract Refract Surg 2004; 30: 2636–2637.Google Scholar
Frieman BJ, Friedberg MA. Globe perforation associated with subtenon's anesthesia. Am J Ophthalmol 2001; 131: 520–521.Google Scholar
Jaycock PD, Mather CM, Ferris JD, Kirkpatrick JNP. Rectus muscle trauma complicating sub-Tenon's local anaesthesia. Eye 2001; 15: 583–586.Google Scholar
Kim SK, Andreoli CM, Rizzo III JF, Golden MA, Bradbury MJ. Optic neuropathy secondary to sub-Tenon anesthetic injection in cataract surgery. Arch Ophthalmol 2003; 121: 907–909.Google Scholar
Patel JI, Jenkins L, Benjamin L, Webber S. Dilated pupils and loss of accommodation following diode panretinal photocoagulation with sub-Tenon local anaesthetic in four cases. Eye 2002; 16: 628–632.Google Scholar
Moshfeghi DM, Lowder CY, Roth DB, Kaiser PK. Retinal and choroidal vascular occlusion after posterior sub-Tenon triamcinolone injection. Am J Ophthalmol 2002; 134: 132–134.Google Scholar
Ruschen H, Bremner FD, Carr C. Complications after sub-Tenon's eye block. Anesth Anal 2003; 96: 273–277.Google Scholar
Au Eong KG, Lim TH, Lee HM, Yong VS. Subjective visual experience during phacoemulsification and intraocular lens implantation using retrobulbar anesthesia. J Cataract Refract Surg 2000; 26: 842–846.Google Scholar
Au Eong KG, Low CH, Heng WJ et al. Subjective visual experience during phacoemulsification and intraocular lens implantation under topical anesthesia. Ophthalmology 2000; 107: 248–250.Google Scholar
Murdoch IE, Sze P. Visual experience during cataract surgery. Eye 1994; 8: 666–667.Google Scholar
Rengaraj V, Radhakrishnan M, Au Eong KG et al. Visual experience during phacoemulsification under topical versus retrobulbar anesthesia: results of a prospective, randomized, controlled trial. Am J Ophthalmol 2004; 138: 782–787.Google Scholar
Prasad N, Kumar CM, Patil BB, Dowd TC. Subjective visual experience during phacoemulsification cataract surgery under sub-Tenon's block. Eye 2003; 17: 407–409.Google Scholar
Wickremasinghe SS, Tranos PG, Sinclair N, Andreou PS, Harris ML, Little BC. Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia. Eye 2003; 17: 501–505.Google Scholar
Tan CS, Au Eong KG, Kumar CM. Visual experiences during cataract surgery: what anaesthesia providers should know. Eur J Anesthesiol 2005; in press.Google Scholar
Alwirty A, Koshy Z, Browning AC, Keil W, Holden R. The effect of sub-Tenon's anaesthesia on intraocular pressure. Eye 2001; 15: 733–735.Google Scholar
Pianka P, Weintraub-Padova H, Lazar M, Geyer O. Effect of sub-Tenon's and peribulbar anesthesia on intraocular pressure and ocular pulse amplitude. J Cataract Refract Surg 2001; 27: 1221–1226.Google Scholar
Vallance JH, Patton N, Ferguson A, Bennett HG. Effect of the Honan intraocular pressure reducer in sub-Tenon's anesthesia. J Cataract Refract Surg 2004; 30: 433–436.Google Scholar
Watkins R, Beigi B, Yates M et al. Intraocular pressure and pulsatile ocular blood flow after retrobulbar and peribulbar anaesthesia. Br J Ophthalmol 2001; 85: 796–798.Google Scholar
Waterman H, Mayer S, Lavin MJ, Spencer AF, Waterman C. An evaluation of the administration of sub-Tenon local anaesthesia by a nurse practitioner. Br J Ophthalmol 2002; 86: 524–526.Google Scholar
Katz J, Feldman MA, Bass EB et al. Adverse intraoperative medical events and their association with anesthesia management strategies in cataract surgery. Ophthalmology 2001; 108: 1721–1726.Google Scholar
Haberer JP. Premedication and sedation complications during ophthalmic anaesthesia. J Fr Ophtalmol 2000; 23: 901–906.Google Scholar
Kwok AK, Van Newkirk MR, Lam DS, Fan DS. Sub-Tenon's anesthesia in vitreoretinal surgery: a needleless technique. Retina 1999; 19: 291–296.Google Scholar
Mein CE, Flynn Jr HW. Augmentation of local anesthesia during retinal detachment surgery. Arch Ophthalmol 1989; 107: 1084.Google Scholar
Stevens JD, Franks WA, Orr G, Leaver PK, Cooling RJ. Four-quadrant local anaesthesia technique for vitreoretinal surgery. Eye 1992; 6: 583–586.Google Scholar
Moses KC, Norbury Jr JW. Anesthesia for retinal photocoagulation. Ophthalmic Surg 1990; 21: 156.Google Scholar
Stevens JD, Foss AJ, Hamilton AM. No-needle one-quadrant sub-tenon anaesthesia for panretinal photocoagulation. Eye 1993; 7: 768–771.Google Scholar
Steele MA, Lavrich JB, Nelson LB, Koller HP. Sub-Tenon's infusion of local anesthetic for strabismus surgery. Ophthalmic Surg 1992; 23: 40–43.Google Scholar
Rizzuto PR, Spoor TC, Ramocki JM, McHenry JG. Subtenon's local anesthesia for optic nerve sheath fenestration. Am J Ophthalmol 1996; 121: 326–327.Google Scholar
Ghosh YK, Goodall KL. Postoperative pain relief in vitreoretinal surgery with subtenon bupivacaine 0.75%. Acta Ophthalmol Scand 2005; 83: 119–120.Google Scholar
Inoue M, Takeda K, Morita K, Yamada M, Tanigawara Y, Oguchi Y. Vitreous concentrations of triamcinolone acetonide in human eyes after intravitreal or subtenon injection. Am J Ophthalmol 2004; 138: 1046–1048.Google Scholar
Dutton GN. Sub-Tenon's infiltration of local anaesthetic with hyaluronidase. Br J Ophthalmol 1994; 78: 238.Google Scholar
Kapran Z, Uyar M, Eltutar K, Dincer N. One quadrant sub-Tenon's capsule anesthesia in anterior segment surgery. Eur J Ophthalmol 1996; 6: 131–136.Google Scholar
Khoo BK, Lim TH, Yong V. Sub-Tenon's versus retrobulbar anesthesia for cataract surgery. Ophthalmic Surg Lasers 1996; 27: 773–777.Google Scholar
Briggs MC, Beck SA, Esakowitz L. Sub-Tenon's versus peribulbar anaesthesia for cataract surgery. Eye 1997; 11: 639–643.Google Scholar
Manners TD, Burton RL. Randomised trial of topical versus sub-Tenon's local anaesthesia for small-incision cataract surgery. Eye 1996; 10: 367–370.Google Scholar
Kollarits CR, Jaweed S, Kollarits FJ. Comparison of pain, motility, and preoperative sedation in cataract phacoemulsification patients receiving peribulbar or sub-Tenon's anesthesia. Ophthal Surg Lasers 1998; 29: 462–465.Google Scholar
Nielsen PJ, Allerod CW. Evaluation of local anesthesia techniques for small incision cataract surgery. J Cataract Refract Surg 1998; 24: 1136–1144.Google Scholar
Kwok AK, Van Newkirk MR, Lam DS, Fan DS. Sub-Tenon's anesthesia in vitreoretinal surgery: a needleless technique. Retina 1999; 19: 291–296.Google Scholar
Azmon B, Alster Y, Lazar M, Geyer O. Effectiveness of sub-Tenon's versus peribulbar anesthesia in extracapsular cataract surgery. J Cataract Refract Surg 1999; 25: 1646–1650.Google Scholar
Zafirakis P, Voudouri A, Rowe S et al. Topical versus sub-Tenon's anesthesia without sedation in cataract surgery. J Cataract Refract Surg 2001; 27: 873–879.Google Scholar
Verma SR, Makker RH. Sub-Tenon eye block: approaching the ideal? Anesthesiology 2001; 94: 376–377.Google Scholar
Kansal S, Moster MR, Gomes MC, Schmidt Jr CM, Wilson RP. Patient comfort with combined anterior sub-Tenon's, topical, and intracameral anesthesia versus retrobulbar anesthesia in trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery. Ophthalmic Surg Lasers 2002; 33: 456–462.Google Scholar
Canavan KS, Dark A, Garrioch MA. Sub-Tenon's administration of local anaesthetic: a review of the technique. Br J Anaesth 2003; 90: 787–793.Google Scholar
Mathew MR, Williams A, Esakowitz L, Webb LA, Murray SB, Bennett HG. Patient comfort during clear corneal phacoemulsification with sub-Tenon's local anesthesia. J Cataract Refract Surg 2003; 29: 1132–1136.Google Scholar