Acute reversible bilateral hearing loss after retrobulbar anesthesia

Area of Science:

• Anesthesiology
• Ophthalmology
• Neuroscience

Background:

• Regional anesthesia (RA) is commonly used in ophthalmic surgery.
• Local anesthetic systemic toxicity (LAST) can cause severe neurological complications.
• Bilateral hearing loss is a rare but significant symptom of LAST.

Observation:

• A patient undergoing retrobulbar block for pars plana vitrectomy developed sudden bilateral hearing loss, mental confusion, and respiratory distress.
• The complication occurred shortly after injection of lidocaine and bupivacaine without procedural sedoanalgesia.
• This presentation suggested impending brainstem anesthesia due to local anesthetic toxicity.

Findings:

• This is the first reported case of bilateral reversible hearing loss after RA without sedoanalgesia.
• 20% lipid emulsion infusion (LEI) was administered for the first time to treat hearing loss as a marker of severe LAST.
• The patient's hearing loss and neurological symptoms gradually improved within hours of LEI administration.

Implications:

• Prompt recognition and intervention are critical for managing severe systemic complications of RA.
• 20% LEI may be a crucial therapeutic option to reverse or halt the progression of brainstem toxicity from local anesthetics.
• This case highlights the importance of considering LEI in patients presenting with neurological symptoms after regional anesthesia.