UNILATERAL SPINAL ANESTHESIA COMBINED WITH LOCAL ANESTHESIA FOR PTOSIS SURGERY

Frontal suspension surgery is the most common procedure for congenital blepharoptosis with poor levator muscle function. In view of long term cosmetic results, frontal suspension with autogenous fascia lata is a gold standard surgery. A 46-year-old patient with bilateral ptosis and poor levator function was scheduled for ptosis surgery. Frontal suspension surgery with autogenous fascia lata1,2 was planned under general anesthesia. Patient had a history of type-II diabetes mellitus and poor control of blood glucose level. He was a heavy smoker and had decreased breath sounds bilaterally on chest examination. We decided to perform unilateral spinal anesthesia instead of general anesthesia for harvesting of fascia lata3 due to patient’s systemic problems and reluctance to general anesthesia. Spinal anesthesia was performed at the L4-5 interspace using a 25 G Quincke needle with the patient placed in the lateral decubitis position and lying on the operated side. Two mL of 0.5% hyperbaric bupivacaine was injected. The patient’s position was maintained for 15 min after injection, then he was turned to supine and fascia lata graft was taken. Five mL of 1% lidocaine was infiltrated into the operative site in both eyes, and frontal suspension was performed by using Crawford technique under local anesthesia.