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.

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Page 32 of 128

patients who agree to it may grow anxious if they feel the slightest tension on or around the eye, or if they feel manipulation of the iris or distention of the anterior chamber. They might even become restless to the point of needing more sedation, which can make matters worse, even if intracameral injection is done. Also, since the eye still moves, patients may not focus properly. If they're sufficiently awake, they can be directed to overcome this obstacle. But if the level of discomfort and non-coopera- tion becomes critical, it may even be necessary to perform a block intraoperatively. Pros and cons of blocks Both retrobulbar and peribulbar blocks have advantages. Retrobulbar blocks, in particular, can provide adequate anes- thesia, akinesia and control of intraocular pressure. With complex procedures or corneal stretching, both offer com- plete anesthesia. They also eliminate the need for topical administration or intracameral injection into the chamber, which may distort it. Blocks also last longer and offer some post-operative analgesia. While blocks have more contraindications and complica- tions, some surgeons feel they're safer and permit smoother operations. They can be administered by well-trained and experienced anesthesia providers. Many patients dread the idea of having "a needle stuck in my eye," even when they're assured that the needle goes outside the eye, not into it. They must clearly understand that it's not that big a deal, that blocks have many benefits, and that they'll be sedated before the block is given. If they understand, most patients are agreeable. But unlike topical anesthesia, blocks carry many potential risks: • Retrobulbar hemorrhage. This uncommon complication is caused by the punc- turing of blood vessels in the retrobulbar space. • Chemosis. This can be caused by rapid injection; minimize the risk by injecting slowly. • Globe puncture. This can occur even when a blunt needle is used with a retrob- ulbar block. M A Y 2 0 1 6 • O U T PA T I E N T S U R G E R Y. N E T • 3 3 Topical or Block? Cataract surgeons usually opt for one or the other, varying only when patients and contraindications call for it.

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