Prolonged peribulbar anaesthesia with indwelling catheter: a preliminary report of 217 cases

We report a technique to prolong peribulbar anaesthesia by repetitive injections of lignocaine through a catheter in the inferotemporal peribulbar space during surgery anticipated to exceed 60 min. After peribulbar anaesthesia by standard percutaneous approach with the eye looking straight, a 19-gauge Tuohy needle was inserted backwards in the sagittal plane and parallel to the 5 degrees slope of the orbit floor, to a distance of less than 3 cm, at the junction of the middle and lateral third of the lower orbital rim. A 23-gauge smooth catheter was advanced up to the tip of the needle which was withdrawn, keeping less than 3 cm of catheter in the inferotemporal compartment. A catheter was inserted in 217 consecutive patients undergoing vitrectomy, retinal detachment and retinal peeling. There were no technical difficulties. Neither additional sedation nor general anaesthesia was required during surgery, but less than 50% of patients requested lignocaine injections to supplement anaesthesia. Catheter insertion into the peribulbar space may represent a potential technique to perform a greater variety of ophthalmic surgery with regional anaesthesia. Indications should be limited to the longest procedures.