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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 24 – Retrobulbar (Peribulbar) Block


Many anesthesiologists do not commonly perform a retrobulbar (peribulbar) block; rather, it is most often ophthalmologists who employ this extremely useful regional block. The combination of retrobulbar anesthesia and block of the orbicularis oculi muscle allows most intraocular surgery to be performed. This regional block is most useful for corneal, anterior chamber, and lens procedures.

Patient Selection.

The patients who require retrobulbar (peribulbar) anesthesia are principally older individuals who are undergoing ophthalmic operations.

Pharmacologic Choice.

If retrobulbar block is used, 2 to 4 mL of local anesthetic is all that is required to produce adequate retrobulbar anesthesia. Conversely, if the peribulbar approach is chosen (i.e., the needle tip is not purposely inserted through the cone of extraocular muscles), slightly larger volumes, 4 to 6 mL, may be necessary. Once again, almost any of the local anesthetic agents are applicable, with many ophthalmic anesthetists utilizing combinations of bupivacaine and lidocaine.

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