Effect of pressure-reducing devices on the quality of anterior orbit anesthesia

Needle length is an important consideration in the safe conduct of ophthalmic blocks. A shorter needle could be used to insert the local anesthetic before the globe equator in the anterior orbit and to direct the injectable posteriorly using Honan's balloon to produce the desired effect. However, the use of pressure-reducing devices is not advisable in procedures with impaired retinal blood flow. The aim of this work was to demonstrate the effect of ocular compression with a Honan's balloon on the quality of peribulbar anesthesia when a short needle was used. The blockades were performed in 120 patients using a 27 G, half-inch-long needle. The needle was inserted into the inferotemporal quadrant adherent to the inferior orbital notch. The 7 to 10 ml of local anesthetic solution, consisting of bupivacaine 0.5%, lidocaine 2% in a ratio of 3:2 with hyaluronidase 5 U/ml, was injected followed by application of Honan's balloon or no compression. Ocular akinesia was assessed 10 min later; if inadequate, supplementary anesthesia was provided. No difference was detected in terms of volume injected, supplementation, and akinesia score. Under the conditions of this study, Honan's balloon did not contribute to the quality of the anterior orbit anesthesia, and the technique can be successfully used when ocular compression is contraindicated.