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The Effect of Peribulbar Block Volume on Intraocular Pressure Change: A Randomized Prospective Study.

Brendan E R Alam1, Steven K Young2, Yuka Kiyota2

  • 1From the Massachusetts Eye and Ear (B.E.R.A., S.K.Y., Y.K., C.M.M., K.O., K.A., E.C.D., C.L., M.M.L., G.A.L., Z.K.L.), Harvard Medical School, Boston, Massachusetts, USA; The University of Texas Medical Branch (BERA), Galveston, Texas, USA.

American Journal of Ophthalmology
|May 15, 2026
PubMed
Summary

A 7 mL peribulbar block (PB) volume is safe and more effective for ophthalmic surgery than a 4 mL volume. This study guides best practices for PB anesthesia, improving surgeon satisfaction.

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Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Surgical Procedures

Background:

  • Peribulbar block (PB) is a common anesthesia for ophthalmic surgery.
  • Evidence-based guidelines for PB best practices are lacking.
  • Optimizing PB volume is crucial for effective anesthesia and patient safety.

Purpose of the Study:

  • To investigate the relationship between peribulbar block solution volume, intraocular pressure (IOP) changes, and anesthesia effectiveness.
  • To provide evidence-based recommendations for optimal PB volume in ophthalmic surgery.

Main Methods:

  • A prospective, randomized, controlled trial involving 50 patients undergoing intraocular surgery.
  • Patients received either 4 mL or 7 mL of PB solution.
  • Intraocular pressure (IOP) was measured pre-block, post-block, and post-massage.
  • Surgeon satisfaction with anesthesia quality was assessed.

Main Results:

  • No significant difference in IOP change between 4 mL and 7 mL PB groups post-block or post-massage.
  • Both groups showed significant IOP decrease after ocular massage.
  • The 7 mL PB group reported significantly higher surgeon satisfaction.

Conclusions:

  • A 7 mL peribulbar block volume is safe and more effective for ophthalmic surgery.
  • Increased PB volume may enhance anesthesia quality and surgeon satisfaction.
  • Findings support optimizing PB volume for improved surgical outcomes.