This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by George, R. B. Articles by Hackett, J. Search for Related Content PubMed PubMed Citation Articles by George, R. B. Articles by Hackett, J.

Bilateral hearing loss following a retrobulbar block

[Surdité bilatérale à la suite d’un bloc rétrobulbaire]

From the Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.

Address correspondence to: Dr. Ronald B. George, Department of Anesthesia, Room 5452 Halifax Infirmary, Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada. Phone: 902-473-2325; Fax: 902-473-9454; E-mail: rbgeorge{at}eastlink.ca

Purpose: Regional anesthesia is the most commonly used oph-thalmological anesthetic technique in Canada and the United States. Brainstem anesthesia is not an uncommon complication of retrobulbar blocks. Anesthesiologists are a prominent ele-ment in the ophthalmology suite, in part due to the complica-tions possible with regional anesthesia. This is the first reported case of complete bilateral hearing loss following a retrobulbar block.

Clinical features: A 46-yr-old male with type 1 diabetes mel-litus presenting for ophthalmological surgery had a retrobulbar block performed by the ophthalmologist. Local anesthetic was injected through a 25 G, 1.5 inch needle, entering the orbit infe-riorly on the temporal third of the lower lid. Shortly after the block was completed the patient experienced sudden hearing loss. On examination the hearing loss appeared to be complete and bilateral. The patient was alert and oriented; the remainder of the cranial nerve exam was normal. The patient’s hearing loss gradually improved and three hours after the block his hearing had subjectively returned to normal.

Conclusion: Brainstem anesthesia is not a rare complication of regional anesthesia for ophthalmological surgery. Symptoms include confusion, mental agitation, dizziness, blurred vision or blindness, ophthalmoplegia, deafness, tinnitus, dysphagia, dys-arthria, respiratory depression to apnea, and/or limb paralysis. A connection between the subdural and subarachnoid spaces and the optic sheath exists. The effect on the central nervous system depends upon the amount of local anesthetic injected and the area to which it spreads.