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Jost B. Jonas, MD; Wido M. Budde, MD; Michael Dinkel, MD; Thomas M. Hemmerling, MD

Arch Ophthalmol. 2000;118:996-1000.

Objective  To evaluate an indwelling temporary retrobulbar catheter for repeatable injections of local anesthetics for long-lasting and titratable retrobulbar anesthesia in intraocular surgery.

Participants  The prospective clinic-based study included 153 patients who underwent vitreoretinal surgery (n=111) or buckling procedures with cryocoagulation (n=34). The mean duration of surgery was 84.7 ± 49.5 minutes (range, 25-310 minutes). Using commercially available retrobulbar needles with a diameter of 0.60 or 0.80 mm and a length of 38 mm, 5 mL of 2% mepivacaine hydrochloride was injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space. The needle was withdrawn and the catheter was fixed. When the patients started to feel pain during surgery, 2 mL of mepivacaine hydrochloride was reinjected through the catheter.

Results  Ten to 240 minutes after the start of the operation, 96 patients needed an intraoperative reinjection of mepivacaine after which they felt comfortable again. Forty-two patients needed a second reinjection of mepivacaine 30 to 270 minutes after the start of the operation, and 13 patients needed a third reinjection 45 to 145 minutes after the start of surgery. Removal of the catheter after surgery was unremarkable. No infections were observed. Microbiologic examination results of the catheter tip were negative for organisms. Diplopia or other motility problems were not detected. Introduction and fixation of the catheter took less than 5 minutes in all patients.

Conclusions  An indwelling temporary retrobulbar catheter for repeatable intraoperative injections of local anesthetics is simple, effective, and useful, and in comparison with general anesthesia, it is a time-saver for long-lasting and titratable local anesthesia in intraocular surgery.

From the Departments of Ophthalmology (Drs Jonas and Budde) and Anesthesiology (Drs Dinkel and Hemmerling), University Erlangen-Nürnberg, Erlangen, Germany. The authors have no proprietary interest in the products or companies described in this article.

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