Grand mal seizures after retrobulbar block.

Area of Science:

• Anesthesiology
• Neurology
• Ophthalmology

Background:

• Retrobulbar block is a common regional anesthesia technique for ophthalmic procedures.
• Potential complications include central nervous system (CNS) toxicity.
• Understanding the mechanisms of CNS toxicity is crucial for patient safety.

Observation:

• Two patients developed seizures shortly after receiving a retrobulbar block.
• The doses of local anesthetic administered were below known intravenous toxic levels.
• No evidence of retrobulbar hemorrhage was observed in either case.

Findings:

• Seizures were attributed to inadvertent direct injection of local anesthetic into the CNS.
• The likely route of administration was via the ophthalmic artery or its dural sheath.
• This suggests a potential pathway for anesthetic spread beyond the intended retrobulbar space.

Implications:

• Highlights the risk of CNS complications even with standard retrobulbar block techniques.
• Emphasizes the importance of meticulous injection technique to avoid intravascular or intra-arterial administration.
• Suggests vigilance for neurological symptoms post-retrobulbar block, even in the absence of hemorrhage.