Potoperative analgeia by reinjection of local anethetic through an indwelling retrobulbar catheter

PURPOE: To evaluate an indwelling retrobulbar catheter for repeatable potoperative retrobulbar injection of local anethetic for titratable analgeia after intraocular urgery. METHOD: The propective tudy included all 124 patient (124 eye) who conecutively underwent retinal or cyclocryocoagulation (n = 22), par plana vitrectomy, or retinal detachment urgery (n = 102), and who were operated on by the ame urgeon with local anetheia within a period of 12 month. Uing commercially available retrobulbar needle with a diameter of 0.60 mm or 0.80 mm and a length of 38 mm, 5 ml of mepivacaine 2% with hyaluronidae were injected. Through the ame needle, a 28-gauge commercially available flexible catheter wa introduced into the retrobulbar pace, the needle wa withdrawn, and the catheter wa fixed in place. When the patient tarted to feel pain after urgery, 2 ml of mepivacaine 2% or 2 ml of bupivacaine 0.75% were reinjected through the catheter. The catheter wa removed 24 to 72 hour after urgery. REULT: Becaue of increaing pain in the potoperative period, 93 patient (93 of 124, or 75%) received a reinjection 4.2 ± 2.0 hour after the preoperative injection. eventy patient received a econd reinjection after an additional 2.7 ± 1.9 hour, and 42 patient received a third reinjection 3.1 ± 2.0 hour later. After each reinjection, the patient became pain free. Removal of the catheter after urgery wa unremarkable. CONCLUION: An indwelling retrobulbar catheter for repeatable potoperative injection of hort-acting local anethetic i ueful and effective for titratable potoperative analgeia after intraocular urgery, and it allow patient to avoid the ide effect of ytemic analgeic and edative.