Brainstem anaesthesia following single medial canthal peribulbar block: A case report and review

We report the first case of brainstem anaesthesia following a single medial canthal block in a patient scheduled for cataract surgery and explore the factors that set the stage for this serious complication. These include relatively short axial length of globe, needle trajectory, position of the needle tip in relation to the posterior plane of the globe and, the optic nerve. We introduce the concept of ‘Cornea to Canthus distance’ and urge that it is factored in when estimating the depth of needle tip during medial canthal peribulbar approach to avoid inadvertent retrobulbar intraconal injection. This case highlights that ingress of local anaesthetic into subarachnoid space is unpredictable, and may occur without direct neural breach. The case unfortunately was also complicated with a challenging airway. We reiterate the importance of the immediate availability of advanced resuscitative facilities, and, an experienced anaesthetist for all units providing regional ophthalmic anaesthesia.
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research