Controlled sedation, sphenopalatine and nasociliary blocks, and bloodless flap suturing in dacryocystorhinostomy

Recently general anesthesia has become more popular than local for dacryocystorhinostomy, but the increasing bleeding tendency has hindered precise suturing of the nasal and lacrimal flaps. This paper describes a method of achieving controlled sedation with meperidine and chlorpromazine, postural sphenopalatine block with a mixture of cocaine and epinephrine, and nasociliary block with lidocaine. The dry field permits precise suturing of the mucosal flaps and has enabled the authors to gain experience with the miniature aneurysm needle of Reverdin, which facilitates suturing, and with Guibor's canaliculus intubation set, which is especially useful when flap suturing is not possible. Of 20 patients in whom this method was used, 16 obtained relief from dacryocystitis or tearing. Retrobulbar hemorrhage occurred in one patient during induction of the nasociliary block, necessitating cancellation of the operation, and pneumonitis occurred postoperatively in another patient. Respiratory gas exchange was normal when tested. The controlled sedation induced a fall in blood pressure and a rise in heart rate. No adverse effects of any of the drugs were noted. Thus, this method of controlled sedation and regional anesthesia is safe and effective, and because it reduces the bleeding tendency it makes the operation easier and shorter.