Retrobulbar Block

Excerpt

The retrobulbar blockade was first described by Herman Knapp in 1884. That same year, Carl Koller reported a case of successful ocular enucleation using cocaine hydrochloride as an anesthetic agent. Years later, Atkinson (1936) described a retrobulbar technique that rapidly became popular; however, the high incidence of complications made this technique obsolete over time. Since then, several anesthesia techniques for ophthalmological surgery have been added to the repertoire of the anesthesiologist.

Modern techniques for retrobulbar blockade have long been considered the gold standard for akinesia and anesthesia in intraocular surgery. However, complications related to this technique, though rare, are devastating and potentially life or sight-threatening. This block has therefore been replaced by some providers with newer techniques with theoretically less severe complications, such as peribulbar blockade and the Sub-Tenon block, which has a similar profile for anesthesia and akinesia as a retrobulbar blockade. Despite this, some still prefer local anesthesia over regional blocks for certain ocular procedures.