The Effect of Peribulbar Block Volume on Intraocular Pressure Change: A Randomized Prospective Study.
Alam Brendan E R, Young Steven K, Kiyota Yuka, Mullaly Catherine M, Oh Kyung, Agarwal Kanika, Davies Emma C, Liu Catherine, Lin Michael M, Lozada Gustavo A
AI Summary
This study found that 7mL peribulbar blocks, compared to 4mL, led to significantly higher surgeon satisfaction for eye surgery, while both volumes safely reduced intraocular pressure after massage.
Abstract
Purpose
Peribulbar block (PB) is a widely used anesthesia modality in ophthalmic surgical procedures globally. There are no evidence-based guidelines on PB best practices available. We studied the relationship between block solution volume, the change in intraocular pressure (IOP) and anesthesia effect to guide practice.
Design
Prospective, controlled, 1:1 randomized, interventional study carried out at two ambulatory surgical centers.
Subjects
Ambulatory male and female patients between age 18 and 79 years of age undergoing planned intraocular surgery with PB as the designated anesthesia modality per surgeon's instruction prior to study enrollment. Eyes with any previous ocular procedure or surgery, or any orbital surgery were excluded. Eyes with corneal scars or cornea edema were also excluded.
Methods
Prior to the scheduled ophthalmic surgery, the enrolled eye was randomized to either 4 mL or 7 mL block volume immediately before PB administration by one of the five anesthesiologists. A regimented 2-minute manual massage was performed by the same research assistant after every block. IOPs were measured with a freshly calibrated tonopen before-block, immediate after-block, and after-manual massage, twice at each time point. Immediately after the completion of the intended surgery, the surgeon was asked to fill the anesthesia satisfaction sheet while staying masked to the block volume.
Main outcome measures
IOP changes at each step and the surgeons' rating of the quality of anesthesia.
Results
There were 50 eyes completed the trial with 25 eyes in each group. There was no statistically significant difference between the two groups in terms of IOP change after the block or after the massage; both groups' IOP decreased significantly after the ocular massage. The 7-mL group achieved a significantly higher surgeon satisfaction score.
Conclusion
7-mL PB was shown to be a safe and more effective method for ocular surgical procedures.
Key Concepts5
The 7 mL peribulbar block (PB) group achieved a significantly higher surgeon satisfaction score compared to the 4 mL group in 50 eyes undergoing ophthalmic surgery.
7 mL peribulbar block (PB) was shown to be a safe and more effective method for ocular surgical procedures.
There was no statistically significant difference between the 4 mL and 7 mL peribulbar block (PB) groups in terms of intraocular pressure (IOP) change after the block or after manual massage in 50 eyes.
Both 4 mL and 7 mL peribulbar block (PB) groups showed a significant decrease in intraocular pressure (IOP) after ocular massage in 50 eyes.
This was a prospective, controlled, 1:1 randomized, interventional study involving 50 eyes from ambulatory male and female patients aged 18-79 years undergoing planned intraocular surgery with peribulbar block (PB).
Related Articles5
Two-Year Outcomes of Phacogoniotomy vs Phacotrabeculectomy for Advanced Primary Angle-Closure Glaucoma With Cataract: A Noninferiority Randomized Clinical Trial.
Randomized Controlled TrialTwo-year outcome of phacogoniotomy for advanced primary angle-closure glaucoma with cataracts: a multicentre study.
Multicentre prospective studyThe Paul Glaucoma Implant: a systematic review of safety, efficacy, and emerging applications.
Systematic ReviewEvaluating High Intraocular Pressure Criteria for Failure in Glaucoma Surgery: Impact on Estimated Success and Visual Field Rates.
Systematic ReviewStandalone Canaloplasty and Trabeculotomy Using the OMNI Surgical System in Patients With Open Angle Glaucoma: A Systematic Review and Meta-analysis.
Systematic ReviewIs this article assigned to the wrong chapter(s)? Let us know.