[Eyelid akinesia after various techniques of facial nerve block]

Lid akinesia was investigated after the application of one of three techniques to achieve facial nerve blockade in each of 32 patients undergoing cataract surgery. Modifications of the O'Brien, Atkinson and Lint block techniques were applied in twelve, ten, and ten patients, respectively. Before and 1, 3, 5 and 10 min after administration of 5 ml 1% lidocaine (Xylocain) with naphazolin nitrate 1:20,000 (Privin) voluntary muscle activity of the orbicularis oculi muscle was recorded, and the area under the EMG curve was calculated for quantitative comparison of muscular activity between the groups. In addition, the force of lid closure was determined with a Müller blepharometer, and lid movements were evaluated on a subjective assessment scale. In six additional patients, the topographic distribution of a mixture of metrizamide (Solutrast) and the anesthetic solution was evaluated radiographically to assess potential causes of differences in the effectiveness of the block techniques. Within 1 min after modified O'Brien block, the voluntary activity of the orbicularis oculi muscle and the force of lid closure were significantly, lower than those after both the modified van Lint and the Atkinson techniques: furthermore, a significant decrease in the voluntary lid movement was observed within 3 min. Whereas the modified O'Brien block nearly abolished voluntary muscle activity, force of lid closure and lid movement, there was only a minor decrease in the area under the EMG curve and in the force of lid closure after the modified van Lint and Atkinson blocks (about 20%).(ABSTRACT TRUNCATED AT 250 WORDS)