Regional anaesthesia for surgical repair in selected open globe injuries in adults

Purpose: To determine whether the combination of topical, intracameral and facial nerve blocks would produce adequate analgesia for repair of open globe injuries without increasing intraocular tension. Methods: A comparison of combined O’Brien’s block (facial nerve block), topical ropivacaine and intracameral lignocaine versus peribulbar block in 100 randomly selected cases of traumatic corneal rupture. Patients were randomly divided in two groups of 50 each based on those receiving the combined approach (Group T) and those undergoing peribulbar block (Group P). Patients were excluded if there was rupture with significant scleral extension, the interval between trauma and presentation greater than 2 h, presence of hypopyon, rupture with significant corneal oedema, expulsion of intraocular contents with a collapsed globe and monocular cases.The effect of the anaesthetic was compared by patient comfort and surgeon comfort, the incidence of vitreous prolapse and the requirement of incremental sedation. The Student’s ‘‘t’’ test, the ‘‘Z’’ test, and Chi Square tests were used where appropriate. P 0.05 was considered statistically significant. Results: The average patient comfort in Group P was 5.67% greater than Group T (P 0.05). The average surgeon comfort and patient comfort between groups were similar (P 0.05, both comparisons). Incremental sedation was required in 16% of patients in Group T compared to 8% in Group P (P = 0.218363). The total sedation dosage required for each group was similar. The incidence of vitreous prolapse was statistically significantly higher by 14% in Group P compared to Group T (P = 0.03731). Conclusions: Our combined technique proved as efficacious as peribulbar block in providing adequate local anaesthesia and reducing the incidence of vitreous prolapse. We recommend greater use of this technique for repair of open globe injuries especially in locations where full time anaesthesia services are not available.