Outpatient Surgery Magazine

The Trouble With Transvaginal Mesh - August 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://outpatientsurgery.uberflip.com/i/713724

Contents of this Issue


Page 31 of 128

On the other hand, surgeons who prefer no eye movement will likely opt for blocks, as will surgeons performing longer or more complex cases. The speed at which the surgeon works is also a consideration. A phacoemulsification with an intraocular lens implant may take anywhere from 10 to 30 minutes. Block types Although other types of blocks are also used occasionally — including the Sub- Tenon's (episcleral) block and the van Lint (lid) block — the blocks of choice for cataract surgery remain the retrobulbar and the peribulbar. • Retrobulbar blocks. They involve injecting local anesthetic inside the muscle cone. They block the ciliary nerves, ciliary ganglion, and cranial nerves III, IV and VI. They're usually deeper than peribulbar blocks and require less volume to attain the goal of no movement and no pain. • Peribulbar blocks. They're usually injected above or below the orbit. The anes- thetic solution is deposited within the orbit, but doesn't enter the muscle cone, which makes them safer overall than retrobulbar blocks. Incidentally, general anesthesia should probably be used only as a last resort — with pediatric patients and/or with patients who can't tolerate blocks, or who can't hold still. More on that later. Pros and cons of topical With topical anesthesia, chemosis and periorbital hematoma are minimal, and sub- conjunctival hemorrhage is rare. Patients may worry that they'll feel pain, but most are amenable when the method is thoroughly explained. And generally, topical is sig- nificantly less painful than the administration of blocks. When patients understand that they won't be completely asleep, but that they'll feel very comfortable and relaxed, both surgeons and patients benefit. As noted, supplementing with appropri- ate sedation improves the topical experience. The risks associated with topical are minimal and it provides rapid eye recovery immediately after surgery. While topical is safe and comfortable, it requires a cooperative patient. Some Anesthesia Alert AA 3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 6

Articles in this issue

Archives of this issue

view archives of Outpatient Surgery Magazine - The Trouble With Transvaginal Mesh - August 2016 - Subscribe to Outpatient Surgery Magazine