Retrobulbar block

[narcusprince]

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For the attendings out there, how many of you actually do your own retrobulbar block??? Is this a skill I should learn for academics and private practice?
Thanks

 

[Planktonmd]

For the attendings out there, how many of you actually do your own retrobulbar block??? Is this a skill I should learn for academics and private practice?
Thanks

I used to do them frequently but not anymore.
There are still some places where the anesthesiologist is expected to do the blocks for eye cases.
Most people do peribulbar blocks because they are safer than retrobulbar blocks and very easy to perform.

 

[mcgreen]

I used to do them frequently but not anymore.
There are still some places where the anesthesiologist is expected to do the blocks for eye cases.
Most people do peribulbar blocks because they are safer than retrobulbar blocks and very easy to perform.

Never done one as a resident or an attending, never been asked to do one as an attending.

 

[jwk]

Most of our cataracts are done with topical. In this day and age, there's really no good reason not to do them that way. Considering that the risks of RBB and even PBB are fairly high compared to the puny reimbursement given, our group no longer does them, but will provide sedation for the block by the ophthalmologist as part of our MAC's for eye cases.

 

[Frank Rizzo]

Blocks always done by optho where I'm at, BUT the optho attendings would gladly teach you if you asked them.
Don't know how legal it was since as a resident my actions were covered by the anesthesia attending. Oh well.

 

[narcusprince]

JWK
As a learning point. I like to point out that with topical you may have anesthesia but you do not have akinesia. I just did a cochrane review which showed an increased rate of complications with topical versus sub-tenon block. Numbers to follow. The study showed a higher rate of surgical complications in training institutions with topical. My thinking is that an akinetic envirorment is optimal for junior surgical hands.

 

[jwk]

JWK
As a learning point. I like to point out that with topical you may have anesthesia but you do not have akinesia. I just did a cochrane review which showed an increased rate of complications with topical versus sub-tenon block. Numbers to follow. The study showed a higher rate of surgical complications in training institutions with topical. My thinking is that an akinetic envirorment is optimal for junior surgical hands.

Of course you do, but fortunately, we're strictly private practice here, so a long cataract for us is 20 minutes, most average about 10-12, and some only take 6-7 minutes. For those surgeons who just have to have a quiet field, they are certainly welcome to use eye blocks - but they have to do them, not us. We were doing topicals long before most even considered it, and only one or two of our non-retinal guys still want blocks. Included among the advantages would be not having to stop anticoagulants pre-operatively, a common issue among this primarily elderly patient population. My dad actually came to Atlanta 15 years ago to have his cataracts done because he couldn't find a single ophthalmologist in St. Louis that would consider doing it under topical and his neurologist refused to take him off coumadin two weeks for the surgery.