Indwelling temporary retrobulbar catheter for long-lasting titratable local anesthesia

Objective: To evaluate an indwelling temporary retrobulbar catheter for rep eatable injections of local anesthetics for long-lasting and titratable ret robulbar anesthesia in intraocular surgery. Participants: The prospective clinic-based study included 153 patients who underwent vitreoretinal surgery (n = 111) or buckling procedures with cryoc oagulation (n = 34). The mean duration of surgery was 84.7 +/- 49.5 minutes (range, 25-310 minutes). Using commercially avail able retrobulbar needles with a diameter of 0.60 or 0.80 min and a length of 38 mm, 5 mL of 2% mepi vacaine hydrochloride was injected. Through the same needle, a 28-gauge com mercially available flexible catheter was introduced into the retrobulbar s pace. The needle was withdrawal and the catheter was fixed. When the patien ts started to feel pain during surgery, 2 mL of mepivacaine hydrochloride w as reinjected through the catheter. Results: Ten to 240 minutes after the start of the operation, 96 patients n eeded an intraoperative reinjection of mepivacaine after which they felt co mfortable again. Forty-two patients needed a second reinjection of mepivaca ine 30 to 270 minutes after the start of the operation, and 13 patients nee ded a third reinjection 45 to 145 minutes after the start of surgery. Remov al of the catheter after surgery was unremarkable. No infections were obser ved. Microbiologic examination results of the catheter tip were negative fo r organisms. Diplopia or other motility problems were not detected. Introdu ction and fixation of the catheter took less than 5 minutes in all patients . Conclusions: An indwelling temporary retrobulbar catheter for repeatable in traoperative injections of local anesthetics is simple, effective, and usef ul, and in comparison with general anesthesia, it is a time-saver for longl asting and titratable local anesthesia in intraocular surgery.