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Continuous retrobulbar anesthesia for scleral buckling surgery using an ultra-fine spinal anesthesia catheter

[L'anesthésie rétrobulbaire continue pendant le cerclage scléral à l'aide d'un cathéter ultra-fin pour la rachianesthésie]

Jost B. Jonas, MD^*, Melanie Jäger^* and Thomas M. Hemmerling, MD

^* From the Department of Ophthalmology Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg Mannheim, Germany, and
the Department Of Anesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montréal, Montréal, Québec, Canada.

Address correspondence to: Dr. J. Jonas, Universitäts-Augenklinik, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Phone: **49-621-383-2652; Fax: **49-621-383-3803; E-mail: Jost.Jonas{at}augen.ma.uni-heidelberg.de

Purpose: To evaluate a novel retrobulbar catheter technique for intraoperative and postoperative analgesia in patients undergoing scleral buckling procedures.

Methods: This prospective noncomparative clinical interventional case-series study included 43 consecutive patients undergoing scleral buckling procedures as treatment of rhegmatogenous retinal detachments. Using a commercially available retrobulbar needle with a diameter of 0.80 mm and a length of 38 mm, 7 mL of local anesthetic were injected into the retrobulbar space. Through the same needle, a 28-gauge commercially available flexible spinal anesthesia catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed. The catheter was removed on the morning of the first postoperative day. When the patients started to feel pain during or after surgery, 2 mL of local anesthetic were re-injected through the catheter.

Results: During surgery, 12 (27.9%) patients received a pain-free re-injection through the retrobulbar catheter resulting in a marked reduction of pain. Two (4.7%) patients needed a second re-injection. In the postoperative period, 23 (53.5%) patients experienced pain of grade 3 or higher 5.4 ± 6.7 hr after start of surgery and received a retrobulbar re-injection. Eleven (25.6%) patients asked for a second postoperative re-injection, and four (9.3%) patients received a third postoperative re-injection. Cardiopulmonary and central nervous adverse effects were not noticed.

Conclusions: Use of an ultra-fine retrobulbar catheter for repeat intraoperative and postoperative injections of local anesthetics is a simple and effective method to achieve analgesia during and after scleral buckling procedures.