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Impressum
Long-Lasting local Anesthesia and Postoperative Analgesia by Re- Injections of local Anesthetics Through an Indwelling Retrobulbar Catheter
1Jäger M., 2Hemmerling T., 1Jonas J. B.
1Augenklinik, Fakultät für klinische Medizin Mannheim, Ruprecht-Karls- Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, 2Department of Anesthesiology, Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montréal, Canada
Purpose: To evaluate a temporary retrobulbar catheter for repeatable
injections of local anesthetics for titrable anesthesia and analgesia
in and after intraocular surgery.
Methods: The prospective study included 191 patients who underwent
vitreo-retinal surgery (n= 130), buckling procedures (n = 47) since April
2000. Through a retrobulbar needle with a diameter of 0.8mm and a length
of 38mm 6 to 8 ml of mepivacaine 2% were injected. Through the same needle
a flexible 28 gauge catheter was introduced in the retrobulbar space,
the needle was withdrawn and the catheter was taped to the skin. When
the patients started to feel pain during and after surgery 2ml of mepivacaine
2% or of ropivacaine 0.75% were re-injected.
Results: Mean duration of surgery was 75.27 ± 39.29 minutes
(range 20 to 220 minutes). Ten to 170 (mean 46.58 ± 31.58) minutes
after start of the operation 129 patients needed an intraoperative re-injection,
49 patients received a second re-injection and 20 patients needed a third
re-injection. 22 patients needed additional systemic analgesia during
the operation. Due to the increasing pain in the postoperative period,
145 patients received a re-injection after 234.86 ± 80.92 minutes,
85 patients needed a second reinjection and 25 patients received a third
re-injection. 71 patients needed additional medication, because 39 patients
had a too small effect of the reinjections, within 16 patients the maximum
amount of local anesthetics was achieved, 35 patients developed ocular
hypertension and 20 patients had removed their catheter themselves too
early. The catheter was removed after about 18.56±9.08 hours. Infections,
prolonged swelling, diplopia or other motility problems were not detected.