Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases

Aims-A prospective study was carried out in order to evaluate the efficacy and safety of peribulbar anaesthesia during keratoplasty and to describe su rgical conditions. Methods-Of 137 consecutive keratoplasties, 100 (73%) were performed under p eribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (r ange 9-22 mi) of a mixture of etidocaine, bupivacaine, and hyaluronidase. O cular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgica l conditions were studied. Results-Before trephination, IOP was 5.73 mm Hg below the preinjection valu e and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 9 4% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraope rative suprachoroidal haemorrhage that did not result in a true expulsive h aemorrhage despite an "open sky" situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. Conclusion-These results demonstrate that peribulbar anaesthesia offers exc ellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery.