Ophthalmic regional block

Cataract surgery is the commonest ophthalmic surgical procedure and a local anaesthetic technique is usually preferred but the provision of anaesthesia in terms of skills and resources varies worldwide. Intraconal and extraconal blocks using needles are commonly used. The techniques are generally safe but although rare, serious sight- and life-threatening complications have occurred following the inappropriate placement of needles. Sub-Tenon's block was introduced as a safe alternative to needle techniques but complications have arisen following this block as well. Currently, there is no absolutely safe ophthalmic regional block. It is essential that those who are involved in the care of these patients have a thorough knowledge of the techniques used. This review article outlines the relevant anatomy, commonly used techniques and their safe performance and perioperative care.

Retrobulbar alcohol injection for orbital pain relief under difficult circumstances: a case report

<p><b>INTRODUCTION</b>A case is presented of a patient with severe and chronic pain in the orbital region, which was relieved by retrobulbar injection of absolute alcohol. The management of chronic pain in the orbital region has received little attention and the literature is reviewed.</p><p><b>CLINICAL PICTURE</b>A 52-year-old man with adenoid cystic carcinoma of the maxillary sinus was suffering from severe pain, especially in the left orbital region. There was also pain from ocular exposure and compression caused by the tumour. Magnetic resonance imaging (MRI) revealed spread of tumour to both orbits, particularly on the left. Multiple debulking surgery and various treatment modalities offered no relief from his pain.</p><p><b>TREATMENT</b>A single retrobulbar injection of 2 mL of absolute alcohol, was placed into the putative orbital apex.</p><p><b>OUTCOME</b>As a consequence of the injection, he had complete resolution of his pain in the 6 months prior to his death.</p><p><b>DISCUSSION</b>Retrobulbar injection of alcohol offers effective pain relief in certain specific conditions characterised by chronic orbital pain when other treatments do not help.</p><p><b>CONCLUSION</b>We have demonstrated that the retrobulbar technique still has a place in our armamentarium.</p>