Abstract
Purpose :
Retrobulbar blockade was for many years considered the standard for anesthesia in intraocular surgery. Complications associated with retrobulbar blockade are rare, but may be potentially sight-threatening. Newer methods of local anesthesia with potentially fewer complications have become common, such as peribulbar blockade, sub-tenon blockade, and topical anesthesia. We conducted a retrospective chart review to determine the prevalence, associated clinical features, and incidence of complications of retrobulbar blockade in ophthalmic surgery at a single tertiary academic institution.
Methods :
A retrospective chart review of patients who underwent ophthalmic surgery using retrobulbar anesthesia at the Duke Eye Center between January 1st, 2013 to October 27th, 2022 was performed. The number of patients who underwent ophthalmic surgery using other forms of local anesthesia, including topical anesthesia, was also determined. Patients who underwent general anesthesia for ophthalmic surgery were excluded. Data was collected on patient demographics, primary procedure codes, surgical complications, and duration of surgery.
Results :
1,118 ophthalmic surgeries performed using retrobulbar block and 11,130 ophthalmic surgeries using topical anesthesia were reviewed. A total of 1,003 patients who underwent retrobulbar block were included. The mean age was 60.4 (SD 4.95, range 17-101), 49.9% were female, and 50.1% were male. Of the surgeries performed, 565 (50.5%) were left-sided, 551 (49.3%) were right-sided, and 2 (0.2%) procedures were bilateral. The three most common procedure codes for cases using retrobulbar block were: 66986 (exchange of intraocular lens), 65730 (penetrating keratoplasty), and 65755 (penetrating keratoplasty in pseudophakia). There was 1 (0.089%) occurrence of retrobulbar hemorrhage, which was left-sided. Out of 241 cases using retrobulbar block with recorded surgery duration, 84.1% of cases had a total duration of less than 89 minutes, 14.5% of cases had a duration 89 to 179 minutes, and 1.2% of cases had a duration over 179 minutes. In comparison, for surgical cases using topical anesthesia, case duration was less than 89 minutes in 99.2% of cases and between 89 and 179 minutes in 0.75% of cases.
Conclusions :
Among patients undergoing retrobulbar block for ophthalmic surgery, complication rates are low (0.089%). Retrobulbar block may be associated with increased operative time in ophthalmic surgery.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.