The Open Anesthesia Journal


Formerly: The Open Anesthesiology Journal

ISSN: 2589-6458 ― Volume 13, 2019
RESEARCH ARTICLE

Effectiveness and Safety of Single Percutaneous Peribulbar Block Using Magnesium Sulphate as an Adjuvant to Local Anesthetics Versus the Standard Peribulbar Block for Strabismus Surgery in Adults



Norhan Aly Sherif1, *, Mayada Khairy Mohamad1, Sameh Galal Taher2, Ahmed Abdou Hannon2, Hesham Mohamed Salem1
1 Department of Anesthesia, Research Institute of Ophthalmology, Cairo, Egypt.
2 Department of Pediatric Ophthalmology and Strabismus, Research Institute of Ophthalmology, Cairo, Egypt.

Abstract

Background:

Peribulbar anesthesia in ophthalmic surgeries is limited by delayed and/or incomplete orbital akinesia and inadequate operative and postoperative analgesia.

Objective:

The aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery.

Methods:

A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered through a single percutaneous peribulbar injection with a short (1 inch) needle, while in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patient's baseline characteristics, perioperative and early postoperative outcomes and follow-up data.

Results:

The elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (1.9 ± 0.7 vs. 3.9 ± 1.0 min, p < 0.001; 2.3 ± 0.7 vs. 4.4 ± 1.2 min, p < 0.001 respectively), and the duration of anesthesia was significantly longer in group I compared with group II (180.0 ± 0.0 vs. 43.0 ± 8.5 min, p < 0.001). The median VAS pain score was significantly lower in group I compared with group II (1.0 vs. 4.0, p < 0.001), and the patient's satisfaction was significantly higher in group I compared with group II (100.0% vs. 25.9%, p < 0.001).

Conclusion:

Co-administration of 100 mg magnesium sulphate with the local anesthetics was effective and safe. It achieved suitable conditions to start surgery rapidly. Further, it improved the quality of operative conditions and patient satisfaction.

Keywords: Adult, Akinesia, Analgesia, Magnesium sulphate, Peribulbar block, Strabismus.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 100
Last Page: 105
Publisher Id: TOATJ-13-100
DOI: 10.2174/2589645801913010100

Article History:

Received Date: 12/07/2019
Revision Received Date: 14/09/2019
Acceptance Date: 24/09/2019
Electronic publication date: 24/10/2019
Collection year: 2019

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© 2019 Sherif et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Correspondence: Address correspondence to this author at the Department of Anesthesia, Research Institute of Ophthalmology, Cairo, Egypt;
E-mail: anesth.sherif@gmail.com






1. INTRODUCTION

Regional anesthesia has been considered the standard method of anesthesia in ophthalmic surgery. It has shown high success rate and safety in different ocular procedures including difficult and extended time surgeries [1Leão P, Castro D, Pacheco M, Soares JC, Afonso D. Outcome of combined peribulbar ropivacaine 0.75% block and general anesthesia for retinal detachment surgery: A randomized controlled study. Egypt J Anaesth 2016; 32(4): 549-53.
[http://dx.doi.org/10.1016/j.egja.2016.08.008]
]. Compared with general anesthesia, the use of regional anesthesia has the advantages of quick patient recovery and shorter hospital stay [2Palte HD. Ophthalmic regional blocks: management, challenges, and solutions. Local Reg Anesth 2015; 8: 57-70.
[http://dx.doi.org/10.2147/LRA.S64806] [PMID: 26316814]
].

Retrobulbar and peribulbar blocks are considered the two main approaches of regional anesthesia in eye surgery. They can achieve suitable conditions for intraocular surgeries, including analgesia and profound akinesia of the globe [3Carneiro HM, Teixeira KI, de Ávila MP, Limongi RM, Magacho L. Comparison of needle path, anesthetic dispersion, and quality of anesthesia in retrobulbar and peribulbar blocks. Reg Anesth Pain Med 2016; 41(1): 37-42.
[http://dx.doi.org/10.1097/AAP.0000000000000340] [PMID: 26650428]
]. However, retrobulbar block technique has many complications such as brainstem anesthesia, globe perforation and retrobulbar hemorrhage [4Ascaso FJ, Peligero J, Longás J, Grzybowski A. Regional anesthesia of the eye, orbit, and periocular skin. Clin Dermatol 2015; 33(2): 227-33.
[http://dx.doi.org/10.1016/j.clindermatol.2014.10.014] [PMID: 25704942]
]. Hence, the Peribulbar Block Anesthesia (PBA) has gained wide acceptance in ophthalmic anesthetic practice [5Abdulrahman AAM, Nmadu A, Mahmoud A. Comparison of one site and two site peribulbar anaesthesia for cataract surgery in Nigerian patients: A randomised, controlled trial. Niger J Ophthalmol 2017; 25(2): 90-4.].

The peribulbar block is a needle-based technique that varies from the retrobulbar block in terms of the depth and angulation of needle placement within the orbit [2Palte HD. Ophthalmic regional blocks: management, challenges, and solutions. Local Reg Anesth 2015; 8: 57-70.
[http://dx.doi.org/10.2147/LRA.S64806] [PMID: 26316814]
]. The rate of major complications under peribulbar anesthesia was reported to be 0.006%. However, its main disadvantage is the need for a larger volume of local anesthetic agent [6Kazancıoğlu L, Batçık Ş, Kazdal H, Şen A, Gediz BŞ, Erdivanlı B. Complication of Peribulbar block: Brainstem anaesthesia. Turk J Anaesthesiol Reanim 2017; 45(4): 231-3.
[http://dx.doi.org/10.5152/TJAR.2017.95881] [PMID: 28868171]
].

Rizzo et al. [7Rizzo L, Marini M, Rosati C, et al. Peribulbar anesthesia: a percutaneous single injection technique with a small volume of anesthetic. Anesth Analg 2005; 100(1): 94-6.
[http://dx.doi.org/10.1213/01.ANE.0000140951.65240.94] [PMID: 15616059]
] evaluated the efficacy and safety of a single medial percutaneous injection technique using a small volume of anesthetic for ocular peribulbar anesthesia, and they reported that it was simple and effective in producing an adequate motor block and surgical anesthesia.

To address the drawbacks of PBA, many additive drugs to local anesthesia have been investigated. These include hyalu-ronidase, adrenaline and sodium bicarbonate [8Zahl K, Jordan A, McGroarty J, Gotta AW. pH-adjusted bupivacaine and hyaluronidase for peribulbar block. Anesthesiology 1990; 72(2): 230-2.
[http://dx.doi.org/10.1097/00000542-199002000-00003] [PMID: 2405735]
], clonidine [9Bharti N, Madan R, Kaul HL, Khokhar SK, Mishra S. Effect of addition of clonidine to local anaesthetic mixture for peribulbar block. Anaesth Intensive Care 2002; 30(4): 438-41.
[http://dx.doi.org/10.1177/0310057X0203000406] [PMID: 12180581]
], corticosteroids [10Weijtens O, Schoemaker RC, Lentjes EG, Romijn FP, Cohen AF, van Meurs JC. Dexamethasone concentration in the subretinal fluid after a subconjunctival injection, a peribulbar injection, or an oral dose. Ophthalmology 2000; 107(10): 1932-8.
[http://dx.doi.org/10.1016/S0161-6420(00)00344-4] [PMID: 11013202]
] and neuromuscular blocking agents [11Aissaoui Y, Belyamani L, Kamili ND. Effect of the addition of rocuronium to local anesthetics for peribulbar block. Acta Anaesthesiol Belg 2010; 61(2): 51-4.
[PMID: 21155437]
, 12Sharkawy RFT, Nematallah E. Efficacy of adding cisatracurium or rocuronium to the local anesthetic used for peribulbar anesthesia in patient undergoing cataract surgery. Benha Med J 2017; 34(1): 33-6.
[http://dx.doi.org/10.4103/1110-208X.206899]
]. However, these agents are also associated with some side-effects such as allergic reactions, bradycardia, sedation, dryness of mouth and systemic neuromuscular blockade [13Sinha R, Sharma A, Ray BR, Chandiran R, Chandralekha C, Sinha R. Effect of addition of magnesium to local anesthetics for peribulbar block: A prospective randomized double-blind study. Saudi J Anaesth 2016; 10(1): 64-7.
[http://dx.doi.org/10.4103/1658-354X.169478] [PMID: 26955313]
].

Magnesium has been used with a local anesthetic solution in different regional anesthesia techniques to decrease the onset time of block and to increase the quality and duration of anesthesia [14Yousef AA, Amr YM. The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective caesarean section using combined spinal-epidural anaesthesia: A prospective double blind randomised study. Int J Obstet Anesth 2010; 19(4): 401-4.
[http://dx.doi.org/10.1016/j.ijoa.2010.07.019] [PMID: 20833531]
-16Gunduz A, Bilir A, Gulec S. Magnesium added to prilocaine prolongs the duration of axillary plexus block. Reg Anesth Pain Med 2006; 31(3): 233-6.
[http://dx.doi.org/10.1097/00115550-200605000-00010] [PMID: 16701189]
]. Few studies evaluated magnesium sul-phate as an adjuvant with the local anesthetic for a peribulbar block in different eye surgeries [17AM E-H. Evaluation of the effect of magnesium sulphate vs. clonidine as adjuvant to local anesthetic during peribulbar block. Ain Shams J Anesthesiol 2011; 4(1): 22-6.-19AbdAlali SA. Mohamed GF, AbdAlmagid AS, & Desoki MAH. Clinical comparative study between Magnesium sulphate versus Rocuronium versus Dexmedetomidine as adjuvants for local anesthetic in peribulbar block for eye surgeries. Egypt J Hosp Med 2018; 73(8): 7204-10.], but no previous studies evaluated it specifically in strabismus surgery.

Currently, no ideal adjuvant for the peribulbar block has been reported. Therefore, the aim of this study was to assess the safety and effectiveness of a single percutaneous peribulbar block technique with 100 mg magnesium sulphate added to the local anesthetics used compared with the standard peribulbar block technique in adult strabismus surgery.

2. PATIENTS AND METHODS

2.1. Study Type and Setting

This single center, prospective cohort study was carried out at the Anesthesia Department, Research Institute of Ophthalmology, Cairo, Egypt during the period from January 2018 to January 2019.

2.2. Inclusion Criteria

  • Age more than 16 years old.
  • ASA I and II (Physical status, American Society of Anesthesiologists).
  • Concomitant strabismus.
  • Patients with previous complications and those refusing general anesthesia.

2.3. Exclusion Criteria

  • Age less than 16 years old.
  • ASA III and IV.
  • Uncooperative patients.
  • Previous extraocular or strabismus surgery.
  • Allergy to local anesthesia.
  • Patient refusal of local anesthesia.

2.4. Data Collection

A total of 54 consecutive patients undergoing strabismus surgery were included in the study. They were divided into two equal groups (27 patients each). In group I, 1 ml (100 mg/ml) magnesium sulphate added to a mixture of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using single percutaneous peribulbar injection with a short (1 inch) needle as described by Rizzo et al. [7Rizzo L, Marini M, Rosati C, et al. Peribulbar anesthesia: a percutaneous single injection technique with a small volume of anesthetic. Anesth Analg 2005; 100(1): 94-6.
[http://dx.doi.org/10.1213/01.ANE.0000140951.65240.94] [PMID: 15616059]
]. While in group II, a mixture of 1 ml saline added to 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) was administered using the standard peribulbar block technique. The collected data included patients’ baseline characteristics, perioperative and early postoperative outcomes and follow-up data.

2.5. Outcome Parameters

2.5.1. Primary

  • Ocular anesthesia, akinesia (onset & duration)
  • Forced duction test
  • Muscle stretch
  • Pain score: The intensity of pain was recorded using a numeric pain rating Visual Analog Scale (VAS).
  • Postoperative alignment
  • Need for intraoperative sedation or local anesthesia supplement

2.5.2. Secondary

  • Incidence of Oculo-Cardiac Reflex (OCR)
  • Postoperative nausea and vomiting
  • Hemodynamic parameters
  • Patient satisfaction (numerically from 0 to 10)
  • Surgical satisfaction (postoperative alignment)

2.6. Statistical Analysis

Data analysis was carried out using SPSS version 22. All numerical variables were checked for normality by Shapiro Wilk test. Normally distributed numerical variables were presented as mean ± Standard Deviation (SD), and differences between the two groups were tested using Independent T-test. Abnormally distributed numerical variables were expressed as the median and interquartile range (25th - 75th percentile) and differences between the two groups were tested using Mann-Whitney test. Categorical variables were summarized as frequencies and percentages, and the association between the variables was tested using X2 tests (Pearson's Chi square for independence or Fisher Exact Tests as appropriate). A p-value of < 0.05 was considered statistically significant.

3. RESULTS

Age and ASA physical status of the studied patients were comparable between the two groups (p > 0.05) as shown in Table 1.

The mean elapsed time before the onset of anesthesia and akinesia of the globe was significantly shorter in group I compared with group II (anesthesia: 1.9 ± .7 min and 3.9 ± 1.0 min, akinesia: 2.3 ± 0.7 min and 4.4 ± 1.2 min, respectively). Additionally, the mean duration of anesthesia was significantly higher in group I (180.0 ± 0.0 min) than in group II (43.0 ± 8.5 min) (Table 2).

During surgery, a positive forced duction test was significantly lower in group I (p = 0.046). Muscle stretch was normal in 24 (88.9%) patients in group I compared to only 5 (18.5%) patients in group II with a statistically significant difference (p < 0.001). There was no need for sedation in group I compared to 17 (63.0%) patients in group II with a statistically significant difference (p < 0.001). Concerning oculo-cardiac reflex, it did not occur in group I (0.0%) but occurred in 9 (33.3%) patients in group II with a statistically significant difference (p = 0.002). The operation was performed successfully in all patients with no significant difference regarding postoperative alignment between both the groups (p = 1.0). During postoperative follow-up, the median VAS pain score was significantly lower in group I compared with group II (<0.001). The need for postoperative analgesia was significantly lower in group I (0.0%) than group II (48.1%). Patient's satisfaction was significantly higher in group I compared to group II (100.0% vs. 25.9% respectively) (Table 3).

Table 1
Baseline characteristics of the studied patients.


Table 2
Comparison of anesthesia and akinesia between the studied groups.


Table 3
Comparison of operative and postoperative outcomes between the studied groups.


4. DISCUSSION

This study demonstrated favorable effects of 100 mg magnesium sulphate as an adjuvant to a mixture composed of 2 ml lidocaine 2%, 2 ml bupivacaine 0.5% and 1 ml hyaluronidase (150 units/ml) in peribulbar anesthesia for strabismus surgery in adults. It accelerated the onset of sensory block and globe akinesia and prolonged the duration of globe anesthesia. Thus, time for suitable conditions to start surgery was enhanced. Moreover, magnesium sulphate addition enhanced the quality of operative conditions. It was associated with more normal muscle stretch, with no need for intraoperative sedation and complete prevention of the life-threatening oculocardiac reflex. Also, it increased the patient's satisfaction with no need for postoperative analgesia, besides the absence of any marked side effects.

Magnesium is an important cation, which is necessary for enzymatic reactions in the human body [20Mukherjee K, Das A, Basunia SR, Dutta S, Mandal P, Mukherjee A. Evaluation of magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Pharm Pract Res 2014; 3(4): 123-9.]. The anesthetic and analgesic effects of magnesium observed in this study could be explained by its function as a physiological calcium channel blocker and noncompetitive antagonist of N-methyl-D-aspartate receptors [21Do SH. Magnesium: A versatile drug for anesthesiologists. Korean J Anesthesiol 2013; 65(1): 4-8.
[http://dx.doi.org/10.4097/kjae.2013.65.1.4] [PMID: 23904932]
]. Also, magnesium sulphate has a high therapeutic index and cost-effectiveness [20Mukherjee K, Das A, Basunia SR, Dutta S, Mandal P, Mukherjee A. Evaluation of magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Pharm Pract Res 2014; 3(4): 123-9.]. Accordingly, appropriate use of magnesium sulphate would improve surgical outcome and patients' satisfaction in strabismus surgery.

In agreement with our findings, Sinha et al. [13Sinha R, Sharma A, Ray BR, Chandiran R, Chandralekha C, Sinha R. Effect of addition of magnesium to local anesthetics for peribulbar block: A prospective randomized double-blind study. Saudi J Anaesth 2016; 10(1): 64-7.
[http://dx.doi.org/10.4103/1658-354X.169478] [PMID: 26955313]
] concluded that the addition of 50 mg magnesium sulphate to the lidocaine-bupivacaine mixture for peribulbar block in adult patients scheduled for elective ophthalmic surgery accelerates the onset of akinesia without any obvious side effect. Likewise, effective and safe use of 50 mg magnesium sulphate in patients who underwent elective posterior segment surgery was reported. Impact of magnesium addition was evidenced by fast onset of globe block, long duration of akinesia and analgesia with excellent patient and surgeon satisfaction, besides the absence of systemic or local complication [18Mohamed AE-R, Osman MH, Ahmed AB, Mohamed A-A, Norhan AS. Evaluation of the effect of using magnesium sulphate as an adjuvant to regional anesthesia for ophthalmic surgery using peribulbar block. Med J Cairo Univ 2016; 84: 283-8.]. Similarly, Abd El-hamid [17AM E-H. Evaluation of the effect of magnesium sulphate vs. clonidine as adjuvant to local anesthetic during peribulbar block. Ain Shams J Anesthesiol 2011; 4(1): 22-6.] reported that the administration of magnesium as a co-factor to the local anesthetic in peribulbar anesthesia for posterior segment eye surgeries accelerated the onset of sensory and motor block without any side effects.

A recent study assessed the efficacy and safety of addition of dexmedetomidine versus magnesium sulphate to the local anesthetic mixture for peribulbar block in cataract surgery. Both the drugs enhanced the onset of globe anesthesia and akinesia with no significant changes in the hemodynamic measurements [22Mohamed AZE, Genidy MM. Magnesium sulphate versus dexmedetomidine as an adjuvant to local anesthetic mixture in peribulbar anesthesia. Egypt J Anaesth 2017; 33(4): 375-80.
[http://dx.doi.org/10.1016/j.egja.2017.07.001]
].

On the other hand, the addition of 50 mg magnesium sulphate to local anesthesia in older (40-80 years-old) patients who underwent cataract surgery did not show any benefit regarding the onset of block or akinesia score [23Bakr RH, Abdelaziz HMM. Rocuronium versus dexmedetomidine as an adjuvant to local anesthetics in peribulbar block: A double blind randomized placebo controlled study. Egypt J Anaesth 2017; 33(3): 221-6.
[http://dx.doi.org/10.1016/j.egja.2017.06.001]
]. AbdAlali et al. [19AbdAlali SA. Mohamed GF, AbdAlmagid AS, & Desoki MAH. Clinical comparative study between Magnesium sulphate versus Rocuronium versus Dexmedetomidine as adjuvants for local anesthetic in peribulbar block for eye surgeries. Egypt J Hosp Med 2018; 73(8): 7204-10.] reported better analgesic and anesthetic effects of rocuronium as an additive to local anesthetic drugs in the peribulbar block than magnesium sulphate. Additionally, Abu Elyazed and Mostafa compared 50 mg of magnesium sulphate and 20 µg fentanyl as additives to a mixture of lidocaine 2% and bupivacaine 0.5% plus 150 IU of hyaluronidase. They found that magnesium could accelerate the onset of globe anesthesia, akinesia and lid akinesia in comparison to the control group, but still can significantly slower than the fentanyl group [24Abu Elyazed MM, Mostafa SF. Fentanyl versus magnesium sulphate as adjuvant to peribulbar anesthesia in cataract surgery. Egypt J Anaesth 2017; 33(2): 159-63.
[http://dx.doi.org/10.1016/j.egja.2017.01.004]
].

Mogahed et al. [25Mogahed MM, Anwar AG, Abo-elazm WN. The effect of adding two different doses of magnesium sulphate as adjuvant to ropivacaine in peribulbar block for cataract surgery. J Anesth Clin Res 2017; 8(5): 725-32.] compared 50 mg versus 100 mg of magnesium sulphate in peribulbar block in cataract surgery. They observed more rapid onset and prolonged duration of akinesia and reduction of the postoperative analgesic requirements with a higher dose of magnesium sulphate. This supports our findings, and together they provide an evidence for using 100 mg regimen of magnesium sulphate to achieve better outcomes. Fortunately, the use of 100 mg magnesium sulphate in the present study was safe with no noticed adverse effects.

Supporting evidence of anesthetic effects of magnesium sulphate was previously recorded. Gunduz et al. [16Gunduz A, Bilir A, Gulec S. Magnesium added to prilocaine prolongs the duration of axillary plexus block. Reg Anesth Pain Med 2006; 31(3): 233-6.
[http://dx.doi.org/10.1097/00115550-200605000-00010] [PMID: 16701189]
] found prolonged sensory and motor block of the axillary nerve when 150 mg magnesium was added to prilocaine without any side effects. When added to bupivacaine, magnesium sulphate improved the onset and the level of the epidural block as well [26Bilir A, Gulec S, Erkan A, Ozcelik A. Epidural magnesium reduces postoperative analgesic requirement. Br J Anaesth 2007; 98(4): 519-23.
[http://dx.doi.org/10.1093/bja/aem029] [PMID: 17324976]
].

Strabismus surgery is frequently associated with OCR, and unfavorable consequences of the reflex such as cardiac arrest and sudden death might occur. So, it is essential to accurately control the heart rate during ophthalmic surgeries [13Sinha R, Sharma A, Ray BR, Chandiran R, Chandralekha C, Sinha R. Effect of addition of magnesium to local anesthetics for peribulbar block: A prospective randomized double-blind study. Saudi J Anaesth 2016; 10(1): 64-7.
[http://dx.doi.org/10.4103/1658-354X.169478] [PMID: 26955313]
]. Different modalities of treatments have been investigated to prevent or alleviate OCR with conflicting findings [27Aletaha M, Bagheri A, Roodneshin F, Mosallaei M, Yazdani S. Oculocardiac reflex during strabismus surgery: Experience from a tertiary hospital. Strabismus 2016; 24(2): 74-8.
[http://dx.doi.org/10.3109/09273972.2016.1170049] [PMID: 27220559]
]. This was considered in our study, and it was observed that magnesium sulphate addition completely inhibited the occurrence of OCR reflex. It is known that OCR reflex is triggered by pressure on the globe, conjunctiva and orbital structures and traction on the extraocular muscles, and its complete inhibition with magnesium sulfate addition to the local anesthetic might be attributed to the deep globe anesthesia and analgesia [28Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol 2019; 19(1): 36.
[http://dx.doi.org/10.1186/s12871-019-0712-z] [PMID: 30871507]
].

CONCLUSION

Co-administration of 100 units magnesium sulphate with the local anesthetic was effective and safe. It achieved suitable conditions to start surgery rapidly and improved the quality of operative conditions and patient satisfaction.

LIST OF ABBREVIATIONS

PBA  = Peribulbar Block Anesthesia
ASA  = American Society of Anesthesiologists
VAS  = Visual Analog Scale
OCR  = Oculo-Cardiac Reflex
SD  = Standard Deviation

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

The protocol of this study was approved by the Research Ethics Committee of the Research Institute of Ophthalmology, Cairo, Egypt. All patients’ data were kept confidential after assigning a code number to each patient, known only by the researchers.

HUMAN AND ANIMAL RIGHTS

No animals were used in the study. All humans research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2008.

CONSENT FOR PUBLICATION

Informed consent was obtained from each patient.

AVAILABILITY OF DATA AND MATERIALS

Not applicable

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Leão P, Castro D, Pacheco M, Soares JC, Afonso D. Outcome of combined peribulbar ropivacaine 0.75% block and general anesthesia for retinal detachment surgery: A randomized controlled study. Egypt J Anaesth 2016; 32(4): 549-53.
[http://dx.doi.org/10.1016/j.egja.2016.08.008]
[2] Palte HD. Ophthalmic regional blocks: management, challenges, and solutions. Local Reg Anesth 2015; 8: 57-70.
[http://dx.doi.org/10.2147/LRA.S64806] [PMID: 26316814]
[3] Carneiro HM, Teixeira KI, de Ávila MP, Limongi RM, Magacho L. Comparison of needle path, anesthetic dispersion, and quality of anesthesia in retrobulbar and peribulbar blocks. Reg Anesth Pain Med 2016; 41(1): 37-42.
[http://dx.doi.org/10.1097/AAP.0000000000000340] [PMID: 26650428]
[4] Ascaso FJ, Peligero J, Longás J, Grzybowski A. Regional anesthesia of the eye, orbit, and periocular skin. Clin Dermatol 2015; 33(2): 227-33.
[http://dx.doi.org/10.1016/j.clindermatol.2014.10.014] [PMID: 25704942]
[5] Abdulrahman AAM, Nmadu A, Mahmoud A. Comparison of one site and two site peribulbar anaesthesia for cataract surgery in Nigerian patients: A randomised, controlled trial. Niger J Ophthalmol 2017; 25(2): 90-4.
[6] Kazancıoğlu L, Batçık Ş, Kazdal H, Şen A, Gediz BŞ, Erdivanlı B. Complication of Peribulbar block: Brainstem anaesthesia. Turk J Anaesthesiol Reanim 2017; 45(4): 231-3.
[http://dx.doi.org/10.5152/TJAR.2017.95881] [PMID: 28868171]
[7] Rizzo L, Marini M, Rosati C, et al. Peribulbar anesthesia: a percutaneous single injection technique with a small volume of anesthetic. Anesth Analg 2005; 100(1): 94-6.
[http://dx.doi.org/10.1213/01.ANE.0000140951.65240.94] [PMID: 15616059]
[8] Zahl K, Jordan A, McGroarty J, Gotta AW. pH-adjusted bupivacaine and hyaluronidase for peribulbar block. Anesthesiology 1990; 72(2): 230-2.
[http://dx.doi.org/10.1097/00000542-199002000-00003] [PMID: 2405735]
[9] Bharti N, Madan R, Kaul HL, Khokhar SK, Mishra S. Effect of addition of clonidine to local anaesthetic mixture for peribulbar block. Anaesth Intensive Care 2002; 30(4): 438-41.
[http://dx.doi.org/10.1177/0310057X0203000406] [PMID: 12180581]
[10] Weijtens O, Schoemaker RC, Lentjes EG, Romijn FP, Cohen AF, van Meurs JC. Dexamethasone concentration in the subretinal fluid after a subconjunctival injection, a peribulbar injection, or an oral dose. Ophthalmology 2000; 107(10): 1932-8.
[http://dx.doi.org/10.1016/S0161-6420(00)00344-4] [PMID: 11013202]
[11] Aissaoui Y, Belyamani L, Kamili ND. Effect of the addition of rocuronium to local anesthetics for peribulbar block. Acta Anaesthesiol Belg 2010; 61(2): 51-4.
[PMID: 21155437]
[12] Sharkawy RFT, Nematallah E. Efficacy of adding cisatracurium or rocuronium to the local anesthetic used for peribulbar anesthesia in patient undergoing cataract surgery. Benha Med J 2017; 34(1): 33-6.
[http://dx.doi.org/10.4103/1110-208X.206899]
[13] Sinha R, Sharma A, Ray BR, Chandiran R, Chandralekha C, Sinha R. Effect of addition of magnesium to local anesthetics for peribulbar block: A prospective randomized double-blind study. Saudi J Anaesth 2016; 10(1): 64-7.
[http://dx.doi.org/10.4103/1658-354X.169478] [PMID: 26955313]
[14] Yousef AA, Amr YM. The effect of adding magnesium sulphate to epidural bupivacaine and fentanyl in elective caesarean section using combined spinal-epidural anaesthesia: A prospective double blind randomised study. Int J Obstet Anesth 2010; 19(4): 401-4.
[http://dx.doi.org/10.1016/j.ijoa.2010.07.019] [PMID: 20833531]
[15] Ghatak T, Chandra G, Malik A, Singh D, Bhatia VK. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine. Indian J Anaesth 2010; 54(4): 308-13.
[http://dx.doi.org/10.4103/0019-5049.68373] [PMID: 20882172]
[16] Gunduz A, Bilir A, Gulec S. Magnesium added to prilocaine prolongs the duration of axillary plexus block. Reg Anesth Pain Med 2006; 31(3): 233-6.
[http://dx.doi.org/10.1097/00115550-200605000-00010] [PMID: 16701189]
[17] AM E-H. Evaluation of the effect of magnesium sulphate vs. clonidine as adjuvant to local anesthetic during peribulbar block. Ain Shams J Anesthesiol 2011; 4(1): 22-6.
[18] Mohamed AE-R, Osman MH, Ahmed AB, Mohamed A-A, Norhan AS. Evaluation of the effect of using magnesium sulphate as an adjuvant to regional anesthesia for ophthalmic surgery using peribulbar block. Med J Cairo Univ 2016; 84: 283-8.
[19] AbdAlali SA. Mohamed GF, AbdAlmagid AS, & Desoki MAH. Clinical comparative study between Magnesium sulphate versus Rocuronium versus Dexmedetomidine as adjuvants for local anesthetic in peribulbar block for eye surgeries. Egypt J Hosp Med 2018; 73(8): 7204-10.
[20] Mukherjee K, Das A, Basunia SR, Dutta S, Mandal P, Mukherjee A. Evaluation of magnesium as an adjuvant in Ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded randomized controlled study. J Pharm Pract Res 2014; 3(4): 123-9.
[21] Do SH. Magnesium: A versatile drug for anesthesiologists. Korean J Anesthesiol 2013; 65(1): 4-8.
[http://dx.doi.org/10.4097/kjae.2013.65.1.4] [PMID: 23904932]
[22] Mohamed AZE, Genidy MM. Magnesium sulphate versus dexmedetomidine as an adjuvant to local anesthetic mixture in peribulbar anesthesia. Egypt J Anaesth 2017; 33(4): 375-80.
[http://dx.doi.org/10.1016/j.egja.2017.07.001]
[23] Bakr RH, Abdelaziz HMM. Rocuronium versus dexmedetomidine as an adjuvant to local anesthetics in peribulbar block: A double blind randomized placebo controlled study. Egypt J Anaesth 2017; 33(3): 221-6.
[http://dx.doi.org/10.1016/j.egja.2017.06.001]
[24] Abu Elyazed MM, Mostafa SF. Fentanyl versus magnesium sulphate as adjuvant to peribulbar anesthesia in cataract surgery. Egypt J Anaesth 2017; 33(2): 159-63.
[http://dx.doi.org/10.1016/j.egja.2017.01.004]
[25] Mogahed MM, Anwar AG, Abo-elazm WN. The effect of adding two different doses of magnesium sulphate as adjuvant to ropivacaine in peribulbar block for cataract surgery. J Anesth Clin Res 2017; 8(5): 725-32.
[26] Bilir A, Gulec S, Erkan A, Ozcelik A. Epidural magnesium reduces postoperative analgesic requirement. Br J Anaesth 2007; 98(4): 519-23.
[http://dx.doi.org/10.1093/bja/aem029] [PMID: 17324976]
[27] Aletaha M, Bagheri A, Roodneshin F, Mosallaei M, Yazdani S. Oculocardiac reflex during strabismus surgery: Experience from a tertiary hospital. Strabismus 2016; 24(2): 74-8.
[http://dx.doi.org/10.3109/09273972.2016.1170049] [PMID: 27220559]
[28] Arnold RW, Bond AN, McCall M, Lunoe L. The oculocardiac reflex and depth of anesthesia measured by brain wave. BMC Anesthesiol 2019; 19(1): 36.
[http://dx.doi.org/10.1186/s12871-019-0712-z] [PMID: 30871507]

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Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


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(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

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Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


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(Delft University of Technology, The Netherlands)

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(Sapienza - University of Rome, Italy)

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(Paris University, France)

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Peter Chiba
(University of Vienna, Austria)

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(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
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Kenji Hashimoto
(Chiba University, Japan)

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Jih Ru Hwu
(National Central University, Taiwan)


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