Minimum effective volume of local anesthetic in peribulbar block: does it differ with the eyeball axial length?

Sanaa M El Fawal, Walid H Nofal, Eman A S Sabek, Wail Ahmed Abdelaal, Sanaa M El Fawal, Walid H Nofal, Eman A S Sabek, Wail Ahmed Abdelaal

Abstract

Background: Peribulbar Anesthesia (PBA) is a relatively safe method for cataract surgery. The anesthetic volume should be adjusted according to the axial eyeball length. Thus, using Minimum Effective Volume (MEV) of local anesthetic helps avoiding unnecessary volumes, preventing increases in intra-ocular pressure, and producing satisfactory conditions for cataract surgery. This study aims to determine the MEV90 of local anesthetics in relation to eye globe axial length in peribulbar blocks for cataract surgery.

Methods: Patients scheduled for cataract extraction under local anesthesia were divided according to their axial eyeball length; Group 1 included those with axial length from 22 to 24 mm, Group 2 included patients with axial length from 24.1 to 26 mm. The initial volume used was 7 mL of a solution of bupivacaine 0.5% (3 mL) + lidocaine 2% (3 mL) + hyaluronidase 150 IU (1 mL). The subsequent volumes were dependent on the response of the previous patient, by using a Bias Coin Design (BCD) and Up and Down Method (UDM) for MEV-90 determination.

Results: The study was concluded with 119 patients. Sixteen patients needed supplemental volume of local anesthetic in Group 1 and thirteen in Group 2. The MEV90 for Group 1 was approximately 5.82 mL (95% CI 5.6 to 5.87 mL) and 5.45 mL for Group 2 (95% CI 5.38 to 5.91 mL). No major complications were noted. There was a negative correlation between the effective volume of LA and eye globe axial length in both groups (p = 0.001).

Conclusion: The MEV90 of local anesthetics for peribulbar block show a strong and inverse correlation with eye globe axial length. This may help achieving an effective block with minimum complications.

Trial registration: ClinicalTrials.gov NCT04036201.

Keywords: Axial eyeball length; Minimum effective volume; Peribulbar anesthesia.

Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
CONSORT flowchart for the details of the study conduct.
Figure 2
Figure 2
Patients’ responses in Group 1 (Panel A) and in Group 2 (Panel B) to different volumes given, the reference line indicates the MEV90. Response to LA volumes ●Success ○ Failure; LA, Local Anesthetic; MEV90, Minimum effective volume of local anesthetic to 90% successful response.
Figure 3
Figure 3
Correlation between the eye globe axial length and the volumes of LA given in cases of successful responses in Group 1 (Panel A) and in Group 2 (Panel B). The p-values indicates significant correlations. LA, Local Anesthetic.

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