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With modern cataract technique, I think topical alone + PO valium is totally reasonable. It's minimally more invasive than LASIK nowadays. Our involvement is largely vestigial, left over from the time of retrobulbar blocks and strapping racquet balls to patients faces.
Although now I've gone and ruined that cataract gravy train we've all be riding.
I've done a total of 0 cataracts in residency. I don't even know how to do them
I've done a total of 0 cataracts in residency. I don't even know how to do them
In my experience there’s never been a gravy train, and the anthem thing is a total non-issue. I’ve done my fair share of anesthesia for cataracts between residency and being an attending, and can probably count on one hand the number that are non-Medicare.
That said, if ophtho wants to do them w topical and Valium, fine by me. Most of us can find something better to do with our lives than get paid Medicare rates for hand-holding anesthesia.
I've done a total of 0 cataracts in residency. I don't even know how to do them
2 of Versed, 30mg Prop for the retrobulbar block, try to stay awake.
I work with a 2 retina guys who talk their patients through the block. No propofol necessary.
Ah yes, the old "6:2:2" method.You only give 30 mg prop for a retrobulbar? Damn dude at least give something for analgesia. That's basically like giving someone a back massage then stabbing them in the eye. We do an prop:alfentanil:lido mixture that works pretty well.
Solo alfenta is more than enough.You only give 30 mg prop for a retrobulbar? Damn dude at least give something for analgesia. That's basically like giving someone a back massage then stabbing them in the eye. We do an prop:alfentanil:lido mixture that works pretty well.
I work with a 2 retina guys who talk their patients through the block. No propofol necessary.
Three guys we work with give po benzo preop, then eye drops. Of my last 100 patients or so, I gave one of them 1mg midaz, and that was for a longer corneal transplant."Ok ma'am just hold steady while I bring this big ass needle right towards your eye.."
"Ok ma'am just hold steady while I bring this big ass needle right towards your eye.."
Not when it’s a first year optho resident.It’s a tiny needle and they’re very gentle.
The comfort of the patient is directly related to how slick the ophthalmologist is doing the block. We have eye docs that range from super gentle (i.e.: wouldn't wake a sleeping baby) to caveman status.
As an aside, I'm shocked to hear that so many of your guys' eye docs are still doing retrobulbar blocks for straightforward cataracts...
As an aside, I'm shocked to hear that so many of your guys' eye docs are still doing retrobulbar blocks for straightforward cataracts...
It’s a tiny needle and they’re very gentle.
Then what are you doing there?I work with a 2 retina guys who talk their patients through the block. No propofol necessary.
There are certain cases and patients where a block is preferred over topical by the surgeon and actually helps them perform the procedure . Many times when the ophtho sees the patient in their office, they know whether it's better to book them for a block vs topicalI wonder if this move is maybe intended to force ophthos to switch to topical anesthesia.
Blocks for cataracts is horse and buggy stuff, man.
There are certain cases
most of us can find something better to do with our lives than get paid Medicare rates for hand-holding anesthesia.
Then what are you doing there?
There are certain cases and patients where a block is preferred over topical by the surgeon and actually helps them perform the procedure . Many times when the ophtho sees the patient in their office, they know whether it's better to book them for a block vs topical
Every needle looks huge when it's going into your eye. Knock me out please.
As an aside, I'm shocked to hear that so many of your guys' eye docs are still doing retrobulbar blocks for straightforward cataracts...
I did a list one day where my borderline senile consultant wanted to literally hand hold the patient under the drapes. The nurse did the same.
It took them 10 mins to figure out they were hand holding each other under the drapes and not the patient's!!
That wasnt a hand.We do the blocks.
they're very safe blocks, take about 1 minute and give excellent akinesis.
the consultant (attending) ophthalmologists don't need it, the trainees do
Huh?That wasnt a hand.
Retrobulbar Anesthesia
RBA was the “gold standard” for eye blocks from the beginning of the 20th century until the formalization of PBA and STA in the 1990s. RBA is achieved by injecting a small volume of local anesthetic agent (3–5 ml) inside the muscular cone. The main hazard of RBA is the risk of injury to the globe, the rectus muscles, or one of the many vulnerable elements located in the muscular cone. Near the apex, these structures are packed in a very small volume and are fixed by the tendon of Zinn, which prevents them from moving away from the needle. Currently, RBA is used less frequently because of these potential complications.
Regional Anesthesia and Eye Surgery | Anesthesiology | ASA Publications
Well then I guess you know more than the ophthos. Bc they tell me firsthand the blocks help with specific patients and with longer and more complex cases, even cataracts. It's actually quicker for them to do the case with topical but they choose to request a block for certain casesSure, but cataracts aren’t one of them. Modern phacoemulsification technique makes blocks completely unnecessary.
Well then I guess you know more than the ophthos. Bc they tell me firsthand the blocks help with specific patients and with longer and more complex cases, even cataracts. It's actually quicker for them to do the case with topical but they choose to request a block for certain cases