BackgroundThe purpose of this study was to evaluate the efficacy and safety of episcleral single-injection anesthesia in a large number of patients. MethodsOver a period of 5 yr, in four institutions, anesthesiologists involved in this prospective study completed a standardized form to evaluate single-injection medial canthus high-volume episcleral anesthesia. The success rate of the block was rated according to an akinesia score. The study parameters included demographic data, surgical procedure, and anesthetic management. All patients were followed up at least until postoperative day 1, and all complications, pain, and discomfort were noted. Statistical analysis was done to assess the risk factors for complications. ResultsA total of 2,031 patients were included in the study. The most frequent surgical procedures performed were phacoemulsification and posterior chamber artificial lens implantation (91.0%). A total of 66 complications (3.3%) occurred in 60 patients. One patient had a retrobulbar hemorrhage, and 59 had one or two more minor incidents or pain/discomfort with the procedure. The complications consisted of subconjunctival hematoma (1.3%), ocular hypertonia (0.4%), and chemosis (0.30%). Statistical analysis revealed that inexperience in the technique represented a risk factor for complications. ConclusionsThis is the first survey of a large experience in episcleral single-injection anesthesia, a form of anesthesia that does not preclude sharp-needle complications and does require training. Only one complication occurred among 2,031 patients; however, a larger number of patients is needed to definitively evaluate the safety of episcleral single-injection anesthesia.

A 40-year-old patient with severe haemophilia A and an inhibitor against factor VIII underwent a cataract extraction under local anaesthesia. Recombinant activated factor VII was use to achieve haemostasis. The procedure was successful. Neither bleeding complications nor side effects occurred.

A randomized double-blind comparison of bupivacaine spinal anesthesia with or without epinephrine was performed in 40 patients age 46-93 years. Three milliliters of hyperbaric 0.5% bupivacaine, with or without 0.3 ml epinephrine, were injected in the subarachnoid space at the second or third lumbar intervertebral space. The dermatomal levels of sensory blockade and the quality of motor blockade were assessed every 5 minutes until 30 minutes and every 15 minutes thereafter. Heart rate and blood pressure were measured at the same intervals, while electrocardiogram (ECG) readings were monitored continuously from induction up to recovery time. The mean cephalad spread of sensory loss was similar in the two groups. There was no significant difference in the time to reach higher level of sensory blockade, but time for two segments regression and for sensory recovery was significantly longer in the epinephrine group. Indeed, the time to onset of complete motor blockade was shorter, although its duration was longer with epinephrine. It was concluded that epinephrine enhanced the duration of sensory and motor blockade when it was added to spinal hyperbaric bupivacaine. The mechanisms of action of vasocontrictors in modifying the effects of local anesthetics remain controversial.