Circumferential perilimbal anesthesia

A new technique was developed that combines topical and subconjunctival sub-Tenon's anesthesia, with the goal of enhancing the topical anesthesia by blocking the perilimbal nerve plexus and the long posterior ciliary nerves as they pass intrasclerally in the horizontal hemimeridians of the eye. In this technique-circumferential peribulbar anesthesia-topical 4% lidocaine hydrochloride (Xylocaine) is administered, followed by a subconjunctival injection of 0.25 cc 4% Xylocaine 3.0 to 4.0 mm superior to the limbus. Then, the anesthetic is spread 360 degrees around the limbus. Medical records and postoperative interviews of 68 consecutive patients having phacoemulsification with circumferential peribulbar anesthesia showed no reports of intraoperative pain.