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BJA Advance Access published online on October 23, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen293
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study

C. Luyet1, U. Eichenberger1,*, B. Moriggl3, L. Remonda2 and R. Greif1

1 Department of Anaesthesiology and Pain Therapy
2 Department of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Inselspital, CH-3010 Bern, Switzerland
3 Department of Anatomy, Histology, and Embryology, Innsbruck Medical University, A-6020 Innsbruck, Austria

* Corresponding author. E-mail: urs.eichenberger{at}insel.ch

Background: Retrobulbar anaesthesia allows eye surgery in awake patients. Severe complications of the blind techniques are reported. Ultrasound-guided needle introduction and direct visualization of the spread of local anaesthetic may improve quality and safety of retrobulbar anaesthesia. Therefore, we developed a new ultrasound-guided technique using human cadavers.

Methods: In total, 20 blocks on both sides in 10 embalmed human cadavers were performed. Using a small curved array transducer and a long-axis approach, a 22 G short bevel needle was introduced under ultrasound guidance lateral and caudal of the eyeball until the needle tip was seen 2 mm away from the optic nerve. At this point, 2 ml of contrast dye as a substitute for local anaesthetic was injected. Immediately after the injection, the spread of the contrast dye was documented by means of CT scans performed in each cadaver.

Results: The CT scans showed the distribution of the contrast dye in the muscle cone and behind the posterior sclera in all but one case. No contrast dye was found inside the optic nerve or inside the eyeball. In one case, there could be an additional trace of contrast dye behind the orbita.

Conclusions: Our new ultrasound-guided technique has the potential to improve safety and efficacy of the procedure by direct visualization of the needle placement and the distribution of the injected fluid. Furthermore, the precise injection near the optic nerve could lead to a reduction of the amount of the local anaesthetic needed with fewer related complications.

Keywords: anaesthetic techniques, regional; anaesthetic techniques, regional, retrobulbar; anatomy; monitoring, ultrasound


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 Br J AnaesthHome page
S. Gayer, H. Palte, C. Kumar, C. Luyet, U. Eichenberger, C. Tappeiner, and R. Greif
Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study
Br. J. Anaesth., April 1, 2009; 102(4): 561 - 562.
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Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study
Steven Gayer, et al.
British Journal of Anaesthesia, 5 Dec 2008 [Full text]
Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study
Cédric Luyet, et al.
British Journal of Anaesthesia, 10 Jan 2009 [Full text]
Real time visualization of ultrasound-guided retrobulbar blockade: an imaging study
Anthony P Rubin
British Journal of Anaesthesia, 17 Jan 2009 [Full text]

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