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document
A comparison of two double-injection techniques for peribulbar block analgesia : infero-temporal plus supero-medial vs. infero-temporal plus medial-percaruncular . BACKGROUND Combinations of infero-temporal and either supero-nasal ( 'inferior-superior ' ) or medial percaruncular ( 'inferior-medial ' ) injections are popular double-injection techniques for establishing peribulbar block analgesia . This study compared the efficacy of these two techniques in achieving ocular and lid akinesia . METHODS One hundred patients were randomized to receive inferior-superior or inferior-medial injections in a study in which injectate , injectate volumes , 5-min ocular akinesia scoring ( 0-8 ) , lid scoring ( 0-2 ) and supplemental injection protocols were standardized . The numbers of supplemental injections required at each observation period and the total volume of injectate required to produce ocular and lid akinesia were compared . RESULTS The two test groups were demographically similar . The inferior-medial combination achieved greater ocular akinesia than the inferior-superior combination 5 min after the initial injections ( mean score +/- standard deviation of 1.74 +/- 1.86 vs. 2.66 +/- 2.39 ; P < 0.05 ) , with a reduced requirement for supplementary injections ( 3 vs. 23 supplementary injections ; P < 0.025 ) . The inferior-superior technique achieved greater lid akinesia at 5 min than the inferior-medial technique ( mean score +/- standard deviation of 0.7 +/- 0.9 vs. 0.3 +/- 0.58 ; P < 0.005 ) . A medial subconjunctival hemorrhage occurred in one patient in the inferior-medial group . CONCLUSION Compared with the inferior-superior technique , the inferior-medial combination achieved more rapid ocular akinesia with less need for supplementation , but induced less efficient lid akinesia and had a propensity to cause iatrogenic subconjunctival hemorrhage . The latter complication is considered by our surgeons to be a contraindication to the inferior-medial technique in patients undergoing trabeculectomy .
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Intervention_Surgical
infero-temporal plus supero-medial vs. infero-temporal plus medial-percaruncular .
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Intervention_Surgical
supero-nasal ( 'inferior-superior ' )
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Intervention_Surgical
medial percaruncular ( 'inferior-medial ' )
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Intervention_Surgical
inferior-superior
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Intervention_Surgical
inferior-medial injections
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Intervention_Surgical
ocular akinesia
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Intervention_Surgical
lid scoring
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Outcome_Physical
ocular akinesia
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Outcome_Physical
lid akinesia
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Outcome_Physical
medial subconjunctival hemorrhage
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Outcome_Physical
rapid ocular akinesia
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Outcome_Physical
iatrogenic subconjunctival hemorrhage
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Outcome_Adverse-effects
.
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Participant_Condition
peribulbar block analgesia
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Participant_Sample-size
One hundred patients
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Participant_Condition
trabeculectomy