Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-16T05:20:34.775Z Has data issue: false hasContentIssue false
  • English
  • Français

A comparison of infero-nasal and infero-temporal sub-Tenon's block

Published online by Cambridge University Press:  27 January 2006

H. McLure ,
C. M. Kumar ,
S. Williamson ,
S. Batta ,
R. Chabria  and
S. Ahmed
H. McLure
Affiliation:
St James's University Hospital, Leeds, UK
C. M. Kumar
Affiliation:
James Cook University Hospital, Middlesbrough, UK
S. Williamson
Affiliation:
James Cook University Hospital, Middlesbrough, UK
S. Batta
Affiliation:
James Cook University Hospital, Middlesbrough, UK
R. Chabria
Affiliation:
James Cook University Hospital, Middlesbrough, UK
S. Ahmed
Affiliation:
St James's University Hospital, Leeds, UK
Get access

Extract

Summary

Background and objective: Sub-Tenon's block is usually delivered by the infero-nasal (IN) approach, but occasionally this may not be possible. The infero-temporal (IT) approach has been described, but data is not available on its efficacy. Methods: One hundred patients undergoing cataract extraction were randomized to receive an IN or IT sub-Tenon's injection of lidocaine 2% with hyaluronidase 15 IU mL−1. Akinesia was assessed using the Brahma scale at 0, 2, 4, 6 and 8 min. Injection, intraoperative and postoperative pain scores (verbal analogue score, 0–10) were noted, along with the incidence of sub-conjunctival haemorrhage and chemosis. Results: There were no differences in patient characteristics data, or mean volume of administered local anaesthetic solution (3.3 (SD = 0.4) mL). There were no significant differences between groups in terms of onset of akinesia. Mean akinesia scores at 2, 4, 6 and 8 min were 2.7, 1.1, 0.4 and 0.2 for Group IN, compared to 2.2, 0.9, 0.8 and 0.3 for Group IT. Chemosis occurred in 14 patients in Group IN, compared to 22 in Group IT (P = 0.21).A sub-conjunctival haemorrhage was noted in 14 patients in Group IN and 19 patients in Group IT (P = 0.52). No patients required supplementary injections. Mean pain scores for the injection, intraoperatively and postoperatively were 0.9, 0 and 0 for Group IN, compared to 1.1, 0 and 0 for group IT. The surgeons scored all the blocks as ‘good’ except for one patient in each group. Conclusions: The IT approach provides an equally rapid onset of block, without a significant increase in complications.

Keywords

ANAESTHESIA LOCAL, eye, sub-Tenon'sinfero-temporal, infero-nasalCATARACT SURGERYLOCAL ANAESTHETIC AGENTS, lidocaineEYE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 282 - 284
Copyright
© 2006 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.)

Footnotes

The abstract of this study was presented in the Annual Scientific Meeting of the European Society of Anaesthesiologists, Vienna, May 2005.

References

Eke T, Thompson J. The National Survey of Local Anaesthesia for ocular surgery: survey methodology and current practice. Eye 1999; 13: 189–195.Google Scholar
Canavan K, Dark A, Garrioch M. Sub-Tenon's administration of local anaesthetic: a review of the technique. Br J Anaesth 2003; 90: 787–793.Google Scholar
Kumar CM, Williamson S, Manickam B. A review of sub-Tenon's block: current practice and recent development. Eur J Anaesthesiol 2005; 22: 567–577.Google Scholar
Stevens J. A new local anaesthesia technique for cataract extraction by one quadrant sub-Tenon's infiltration. Br J Ophthalmol 1992; 76: 670–674.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
Brahma A, Pemberton C, Ayeko M, Morgan L. Single medial injection peribulbar anaesthesia using prilocaine. Anaesthesia 1994; 49: 1003–1005.Google Scholar
Bron AJ, Tripathi R, Tripathi B. Wolf's Anatomy of the Eye and Orbit. London: Chapman and Hall, 1997: 147.
Fischer HBJ, Pinnock CA. Fundamentals of Regional Anaesthesia. UK: Cambridge University Press, 2004: 103–111.
Kumar CM, Dodds C, Fanning GL. Ophthalmic Anaesthesia. The Netherlands: Swets and Zeitlinger, 2002: 66.
Fukasaku H, Marron JA. Sub-Tenon's pinpoint anesthesia. J Cataract Refract Surg 1994; 20: 468–471.Google Scholar
Ripart J, Lefrant JY, Lalourcey L et al. Medial canthus (caruncle) single injection periocular anesthesia. Anesth Analg 1996; 83: 1234–1238.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
Ripart J, Prat-Pradal D, Vivien B, Charavel P, Eledjam JJ. Medial canthus episcleral (sub-Tenon) anesthesia imaging. Clin Anat 1998; 11: 390–395.Google Scholar
Ripart J, Lefrant JY, Vivien B et al. Ophthalmic regional anesthesia: medial canthus episcleral (sub-Tenon) anesthesia is more efficient than peribulbar anesthesia: a double-blind randomized study. Anesthesiology 2000; 92: 1278–1285.Google Scholar
Ripart J, Lefrant JY, L'Hermite J et al. Caruncle single injection episcleral (sub-Tenon) anesthesia for cataract surgery: mepivacaine vs. a lidocaine–bupivacaine mixture. Anesth Analg 2000; 91: 107–109.Google Scholar
Nouvellon E, L'Hermite J, Chaumeron A et al. Ophthalmic regional anesthesia: medial canthus episcleral (sub-Tenon) single injection block. Anesthesiology 2004; 100: 370–374.Google Scholar