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BACKGROUND AND OBJECTIVES: To compare the needle path during retrobulbar ophthalmic block with that during peribulbar ophthalmic block, its relation with anesthetic spread, and the quality of the anesthesia. METHODS: This is a prospective comparative study in selected candidates of ophthalmic blocks for phacoemulsification. The procedure used a 22-gauge 1 needle in a single lateral inferior transcutaneous puncture with 5 mL of anesthetic solution with radiological contrast. Patients were randomly divided into 2 groups: GI, retrobulbar block; GII, peribulbar block. Computed tomography scans of the orbit were performed at the time of the blockade and 10 minutes after anesthetic injection. The quality of anesthesia was assessed by measurement of ocular motility at 3, 5, and 10 minutes after the block. RESULTS: Twenty eyes per group were included. The needle path was intraconal in 10 cases in GI and in no patient in GII, transfixed the muscle cone in 5 cases in GI and in 4 in GII, and was extraconal in 2 cases in GI and in 13 in GII. The anesthetic dispersion was directly related to the needle path. In all extraconal cases, the block was unsatisfactory. It was satisfactory when the path of the needle was intraconal or the cone was transfixed (P = 1.0). The quality of anesthesia was higher in the retrobulbar block (P < 0.01). CONCLUSIONS: The path of the needle contributed to the orbital anesthetic solution dispersion and the quality of anesthesia. The retrobulbar block technique provided better-quality anesthesia compared with the peribulbar one.

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O caso em relato aborda uma etiologia rara para necrose de canto medial da pálpebra com comprometimento do sistema canalicular em uma paciente em tratamento para hanseníase virchowiana. O exame histopatológico da lesão necrótica evidenciou reação inflamatória granulomatosa com acúmulo de histiócitos e presença de bacilos álcool-ácido resistentes. Após tratamento medicamentoso a paciente apresentou uma evolução favorável com recuperação espontânea da arquitetura do canto medial, porém com destruição total do sistema canalicular.

In the present case we deal with a medial eyelid necrosis and injury of the canalicular system in a patient in treatment for lepromatous leprosy. Histology of the necrotic lesion showed granulomatous inflammatory reaction with accumulation of histiocytes and presence of alcohol-acid resistant bacilli. After medical treatment, the patient had a spontaneous recovery of the medial canthus architecture but with complete destruction of the canalicular system.

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In the present case we deal with a medial eyelid necrosis and injury of the canalicular system in a patient in treatment for lepromatous leprosy. Histology of the necrotic lesion showed granulomatous inflammatory reaction with accumulation of histiocytes and presence of alcohol-acid resistant bacilli. After medical treatment, the patient had a spontaneous recovery of the medial canthus architecture but with complete destruction of the canalicular system.

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BACKGROUND AND OBJECTIVES: The objective of this study was to compare the quality and safety of retrobulbar block for the treatment of cataracts by phacoemulsification using needles of different sizes: 27 x 0.70 mm and 20 x 0.55 mm. METHODS: Candidates for ophthalmic block for the treatment of cataracts by phacoemulsification were selected prospectively. After sedation and standardized monitoring, a retrobulbar block with 4 mL of 1% ropivacaine containing hyaluronidase was performed with a single inferolateral puncture. In Group I (GI), the 25 x 0.70 mm needle was used, while in Group II (GII) a 20 x 0.55 mm needle was used. All patients had a CT scan at the time of the blockade and five minutes after the administration of the anesthetic solution with radiologic contrast. Ocular mobility was assessed after three, five, and ten minutes. The incidence of complications in both groups and the satisfaction of patients and surgeons were compared by applying a standardized questionnaire. RESULTS: Fifty-four adult patients were evaluated (27 per group). Patients did not complain of intraoperative pain or perception of light. The anesthetic procedure was considered very good (VG) or excellent (E) in 96.3% of the cases in both groups. All patients were subjected to the same assessment. The need of block repetition between both groups did not differ (p = 1.0). Patients in GI showed decreased ocular mobility at 3 minutes (p = 0.03). The intraconal retrobulbar placement of the needle was observed on both groups. Anesthetic dispersion at 5 minutes was similar in the two groups. CONCLUSIONS: Retrobulbar block with a single inferolateral puncture with a 20 x 0.55 mm needle, using low doses of anesthetics, is an effective and safe option for the treatment of cataracts by phacoemulsification.

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JUSTIFICATIVA E OBJETIVOS: Comparar a qualidade e a segurança da anestesia retrobulbar (ARB) para tratamento de catarata por facoemulsificação utilizando agulhas de dois diferentes tamanhos: 25 x 0,70 mm ou 20 x 0,55 mm. MÉTODOS: Seleção prospectiva de candidatos a bloqueio oftálmico para tratamento de catarata por facoemulsificação. Após sedação e monitorização padronizada, foi realizada anestesia retrobulbar (ARB) em punção única ínfero-lateral com 4 mL de ropivacaína 1 por cento, contendo hialuronidase. No Grupo I (GI) a agulha utilizada foi de 25 x 0,70 mm e no Grupo II (GII), de 20 x 0,55 mm. Em um paciente de cada grupo foram realizadas tomografias computadorizadas no momento da realização do bloqueio oftálmico e após cinco minutos da administração da solução anestésica com contraste radiológico. A mobilidade ocular foi avaliada após três, cinco e dez minutos. Por meio de um questionário padronizado, foram comparadas a incidência de complicações entre os grupos, a satisfação dos pacientes e cirurgiões. RESULTADOS: Foram avaliados 54 pacientes adultos (27 por grupo). Nenhum paciente relatou dor ou percepção luminosa intra-operatória. O procedimento anestésico foi considerado muito bom (MB) ou excelente (E) em 96,30 por cento dos casos nos dois grupos. A mesma avaliação foi feita por 100 por cento dos pacientes. Não houve diferença na necessidade de repetição do bloqueio entre os grupos (p = 1,0). O GI apresentou menor mobilidade ocular aos 3 minutos (p = 0,03). Observou-se o posicionamento da agulha em posição retrobulbar intraconal em ambos os grupos. A dispersão anestésica foi similar entre os grupos aos 5 minutos. CONCLUSÃO: A ARB realizada com a agulha de 20 × 0,55 mm, em punção única ínfero-lateral, utilizando baixas doses de anestésicos, se apresenta como uma opção eficaz e segura para tratamento de catarata por facoemulsificação.

BACKGROUND AND OBJECTIVES: The objective of this study was to compare the quality and safety of retrobulbar block for the treatment of cataracts by phacoemulsification using needles of different sizes: 27 × 0.70 mm and 20 × 0.55 mm. METHODS: Candidates for ophthalmic block for the treatment of cataracts by phacoemulsification were selected prospectively. After sedation and standardized monitoring, a retrobulbar block with 4 mL of 1 percent ropivacaine containing hyaluronidase was performed with a single inferolateral puncture. In Group I (GI), the 25 × 0.70 mm needle was used, while in Group II (GII) a 20 × 0.55 mm needle was used. All patients had a CT scan at the time of the blockade and five minutes after the administration of the anesthetic solution with radiologic contrast. Ocular mobility was assessed after three, five, and ten minutes. The incidence of complications in both groups and the satisfaction of patients and surgeons were compared by applying a standardized questionnaire. RESULTS: Fifty-four adult patients were evaluated (27 per group). Patients did not complain of intraoperative pain or perception of light. The anesthetic procedure was considered very good (VG) or excellent (E) in 96.3 percent of the cases in both groups. All patients were subjected to the same assessment. The need of block repetition between both groups did not differ (p = 1.0). Patients in GI showed decreased ocular mobility at 3 minutes (p = 0.03). The intraconal retrobulbar placement of the needle was observed on both groups. Anesthetic dispersion at 5 minutes was similar in the two groups. CONCLUSIONS: Retrobulbar block with a single inferolateral puncture with a 20 × 0.55 mm needle, using low doses of anesthetics, is an effective and safe option for the treatment of cataracts by phacoemulsification.

JUSTIFICATIVA Y OBJETIVOS: Comparar la calidad y la seguridad de la anestesia retrobulbar (ARB) para tratamiento de catarata por facoemulsificación, utilizando agujas de dos diferentes tamaños: 25 x 0,70 mm o de 20 x 0,55 mm. MÉTODOS: Selección prospectiva de candidatos a bloqueo oftálmico para tratamiento de catarata por facoemulsificación. Después de la sedación y monitoreo estandarizado, se realizó anestesia retrobulbar (ARB) en punción única ínfero-lateral con 4 mL de ropivacaina 1 por ciento, con hialuronidasa. En el Grupo I (GI), la aguja utilizada fue de 25 x 0,70 mm y en el Grupo II (GII), de 20 x 0,55 mm. En un paciente de cada grupo fueron realizadas tomografías computadorizadas al momento de la realización del bloqueo oftálmico y después de cinco minutos de la administración de la solución anestésica con contraste radiológico. La movilidad ocular se evaluó después de tres, cinco y diez minutos. A través de un cuestionario estandarizado, se compararon la incidencia de complicaciones entre los grupos, y la satisfacción de los pacientes y de los cirujanos. RESULTADOS: Fueron evaluados 54 pacientes adultos (27 por grupo). Ningún paciente relató dolor o percepción luminosa intraoperatoria. El procedimiento anestésico fue considerado muy bueno (MB) o excelente (E) en un 96,30 por ciento de los casos en los dos grupos. La misma evaluación se hizo en un 100 por ciento de los pacientes. No hubo diferencia en la necesidad de repetición del bloqueo entre los grupos (p = 1,0). El GI presentó menor movilidad ocular a los 3 minutos (p = 0,03). Se observó el posicionamiento de la aguja en posición retrobulbar intraconal en los dos grupos. La dispersión anestésica fue similar entre los grupos a los 5 minutos. CONCLUSIÓN: La ARB realizada con la aguja de 20 x 0,55mm, en punción única ínfero-lateral, utilizando bajas dosis de anestésicos, se presenta como una opción eficaz y segura para el tratamiento de catarata por facoemulsificación.

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JUSTIFICATIVA E OBJETIVOS: O CEROF-HC é uma instituição pública especializada em oftalmologia. A realização de bloqueios anestésicos para intervenções cirúrgicas oftálmicas é prática comum e eficiente. Como técnica não é isenta de riscos, há possibilidade de perfuração de meninges e a injeção de anestésico local (AL) na região do sistema nervoso central (SNC). O objetivo deste relato foi mostrar um caso de anestesia do tronco encefálico como complicação do bloqueio oftálmico e chamar a atenção para a profilaxia do acidente e o tratamento das complicações. RELATO DO CASO: Paciente do sexo feminino, 60 anos, ASA II, com diagnóstico de catarata grau II, indicada para facectomia com implante de lente intra-ocular no olho direito. Histórico clínico de hipertensão arterial e antecedente de vitrectomia. Exames físicos, laboratoriais e cardiológicos normais. Foi realizado bloqueio retrobulbar extraconal, com anestésico local (lidocaína e bupivacaína) e hialuronidase (volume total de 5 mL). Imediatamente após, a paciente apresentou apnéia e perda da consciência. Foi tratada com intubação traqueal (IOT) e ventilação mecânica, mantendo-se estável. Foi realizada a operação. Começou a se movimentar 30 minutos após IOT, recuperando-se totalmente, sem apresentar qualquer seqüela. CONCLUSÕES: O bloqueio oftálmico, apesar de seguro, não é isento de riscos. O principal fator de risco é a inadequada realização da técnica anestésica. O anestésico local (AL), no bloqueio oftálmico, pode atingir o SNC por punção inadvertida da artéria oftálmica ou por punção das meninges que envolvem o nervo óptico, com a dispersão para o espaço subaracnóideo. Embora rara, pode levar a complicação grave, com parada respiratória, que, se não diagnosticada e tratada prontamente, pode ser fatal. São apresentadas as possibilidades de ocorrência dessa complicação, assim como a discussão da nomenclatura dos bloqueios anestésicos realizados em oftalmologia. Ressalta-se a importância...

BACKGROUND AND OBJECTIVES: The CEROF-HC is a public hospital specialized in ophthalmology. Anesthetic blocks for ophthalmic surgeries are common and effective. But the technique is not devoid of risks, and there is the possibility of meningeal perforation and injection of the local anesthetic (LA) in the central nervous system (CNS). The objective of this study was to report a case of brainstem anesthesia as a complication of the ophthalmologic regional anesthesia, stress the importance of preventing this accident, and discuss the treatment. CASE REPORT: A female patient, 60 years old, ASA II, with a diagnosis of grade II cataract, was scheduled for a facectomy and implantation of intraocular lens in the right eye. The patient had a past medical history of hypertension and vitrectomy. Physical exam, laboratory and cardiologic exams were normal. An extraconal retrobulbar block was performed with local anesthetic (lidocaine and bupivacaine) and hyaluronidase (total volume of 5 mL). Immediately after, the patient developed apnea and loss of consciousness. She was treated with tracheal intubation and mechanical ventilation, remaining stable. The surgery was performed as planned. Thirty minutes after the intubation, the patient began to move, recovering completely, without deficits. CONCLUSIONS: Although safe, ophthalmic block is not devoid of risks. The main risk factor is improper anesthetic technique. In the ophthalmic block, the local anesthetic (LA) can reach the CNS by inadvertently puncturing the ophthalmic artery or the meninges that surround the optic nerve, with dispersion to the subarachnoid space. Although rare, it can lead to a severe complication with respiratory arrest that can be fatal if it is not diagnosed promptly. Here we present the possibilities of such a complication, and discuss the nomenclature of anesthetic blocks used in ophthalmology. The importance of the knowledge of this and other complications by the surgical...

JUSTIFICATIVA Y OBJETIVOS: El CEROF-HC es una institución pública especializada en oftalmología. La realización de bloqueos anestésicos para intervenciones quirúrgicas oftálmicas es una práctica común y eficiente. Como técnica no está exenta de riesgos, existe la posibilidad de perforación de meninges y la inyección de anestésico local (AL) en la región del sistema nervioso central (SNC). El objetivo de este relato fue mostrar un caso de anestesia del tronco encefálico como complicación del bloqueo oftálmico y destacar la profilaxis del accidente y el tratamiento de las complicaciones. RELATO DE CASO: Paciente del sexo femenino, 60 años, ASA II, con diagnóstico de catarata grado II, indicada para facectomía con implante de lente intraocular en el ojo derecho. Hoja clínica de hipertensión arterial y antecedente de vitrectomía. Exámenes físicos, laboratoriales y cardiológicos normales. Fue realizado bloqueo retrobulbar extraconal con anestésico local (lidocaína y bupivacaína) e hialuronidasis (volumen total de 5 mL). Inmediatamente después, la paciente presentó apnea y pérdida de la conciencia. Fue tratada con intubación traqueal (IOT) y ventilación mecánica, manteniéndose estable. Se realizó la operación. Empezó a moverse 30 minutos después del IOT, recuperándose totalmente sin presentar ninguna secuela. CONCLUSIONES: El bloqueo oftálmico, a pesar de seguro, no está exento de riesgos. El principal factor de riesgo es la inadecuada realización de la técnica anestésica. El anestésico local (AL), en el bloqueo oftálmico, puede alcanzar el SNC por punción inadvertida de la arteria oftálmica o por punción de las meninges que envuelven el nervio óptico, con la dispersión para el espacio subaracnoideo. Aunque sea rara, puede conllevar a complicación grave, con parada respiratoria, que, si no se diagnostica y se trata rápidamente, puede ser fatal. Se presentan las posibilidades de esta complicación, y la discusión de la nomenclatura de los bloqueos...

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BACKGROUND AND OBJECTIVES: The CEROF-HC is a public hospital specialized in ophthalmology. Anesthetic blocks for ophthalmic surgeries are common and effective. But the technique is not devoid of risks, and there is the possibility of meningeal perforation and injection of the local anesthetic (LA) in the central nervous system (CNS). The objective of this study was to report a case of brainstem anesthesia as a complication of the ophthalmologic regional anesthesia, stress the importance of preventing this accident, and discuss the treatment. CASE REPORT: A female patient, 60 years old, ASA II, with a diagnosis of grade II cataract, was scheduled for a facectomy and implantation of intraocular lens in the right eye. The patient had a past medical history of hypertension and vitrectomy. Physical exam, laboratory and cardiologic exams were normal. An extraconal retrobulbar block was performed with local anesthetic (lidocaine and bupivacaine) and hyaluronidase (total volume of 5 mL). Immediately after, the patient developed apnea and loss of consciousness. She was treated with tracheal intubation and mechanical ventilation, remaining stable. The surgery was performed as planned. Thirty minutes after the intubation, the patient began to move, recovering completely, without deficits. CONCLUSIONS: Although safe, ophthalmic block is not devoid of risks. The main risk factor is improper anesthetic technique. In the ophthalmic block, the local anesthetic (LA) can reach the CNS by inadvertently puncturing the ophthalmic artery or the meninges that surround the optic nerve, with dispersion to the subarachnoid space. Although rare, it can lead to a severe complication with respiratory arrest that can be fatal if it is not diagnosed promptly. Here we present the possibilities of such a complication, and discuss the nomenclature of anesthetic blocks used in ophthalmology. The importance of the knowledge of this and other complications by the surgical team is paramount, as well as the preparation and adequate monitoring to diagnose and treat immediately this complication to minimize the risks to the patient.