Dex/Dex in eye blocks. Yay or Nay?

[woopedazz]

Anyone here do eyes a lot? What are your thoughts on adding dexamethasone/dexmedetomidine to your mix? What is your mix?

I mainly subtenon and one of my colleagues raves about them... but I'm not sold on it given how foolproof the plain blocks can be.

Faster onset in high turnover lists seems to be the main benefit?

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[dhb]

Anyone here do eyes a lot? What are your thoughts on adding dexamethasone/dexmedetomidine to your mix? What is your mix?

I mainly subtenon and one of my colleagues raves about them... but I'm not sold on it given how foolproof the plain blocks can be.

Faster onset in high turnover lists seems to be the main benefit?

I do a lot of retrobulbar blocks under US. Never thought of adding dex since i don't need the longer block.

 

[GassYous]

yay or nay??

 

[woopedazz]

yay or nay??

Yes or no

 

[pgg]

You guys are actually doing retrobulbar blocks?

F that

 

[Justice4all]

Never done one. Not interested . NO

 

[GassYous]

Yes or no

Yea or nay?

 

[POW16]

Pretty interesting to see it's done routinely by anesthesiologists outside of the US. I've never even seen one here.

 

[GaseousClay]

heck no why add anything near the eye you dont need to.

 

[GassYous]

You guys are actually doing retrobulbar blocks?

F that

Wasn't there a locums guy at mass eye and ear who messed up a bunch of people's eyes doing this

 

[dhb]

You guys are actually doing retrobulbar blocks?

F that

It's pretty easy under US
Hadn't done one either 3y ago

 

[pgg]

It's pretty easy under US
Hadn't done one either 3y ago

The ease or difficulty of the technnique isn't the point, ultrasound or no.

It is interesting to see the different ways you guys do stuff in Europe.

 

[dhb]

The ease or difficulty of the technnique isn't the point, ultrasound or no.

It is interesting to see the different ways you guys do stuff in Europe.

It's not widespread really, just local custom. A majority of case are done with topical anesthesia.
It's actually a peribulbar approach but with US you can redirect the needle to inject behind the globe.

 

[AnesRunner]

Did many in residency. That will be the last time that I ever do a retrobulbar. It's a surgical infiltration (regardless of the use of ultrasound). Have at it, Ophtho. Do your own surgical infiltration. I will do real nerve blocks while you jab needles into your surgical field.

 

[AnesRunner]

Wasn't there a locums guy at mass eye and ear who messed up a bunch of people's eyes doing this

He wasn't at MEEI. Random ASC in western Mass. He resigned his license afterwards. Was in practice for 35 years. Anesthesiologist blamed for causing blindness in 5 cataract patients at Massachusetts clinic: 9 takeaways

It only takes one globe injury to ruin a career.

 

[PlayToWin]

I do thousands of peribulbar annually and rarely have had issues. For retina surgery , the surgeon can do a subtenon . I’m not sure how you can do a subtenon without using surgical instruments to cut away the conjunctiva.

Dex is off label use and I want no part of any lawsuit because retina/glaucoma guy butchered the eyeball!

 

[abolt18]

I do thousands of peribulbar annually and rarely have had issues. For retina surgery , the surgeon can do a subtenon . I’m not sure how you can do a subtenon without using surgical instruments to cut away the conjunctiva.

Dex is off label use and I want no part of any lawsuit because retina/glaucoma guy butchered the eyeball!

But why? Why don't the ophthos just do the peribulbar block themselves? They're literally right there, operating on/in the eye. Seems weird to me that they'd need someone else to do the block.

 

[anbuitachi]

But why? Why don't the ophthos just do the peribulbar block themselves? They're literally right there, operating on/in the eye. Seems weird to me that they'd need someone else to do the block.

had a hand surgeon ask me to do a block on a small hand cause when he was just right there. i told him to do it.

 

[GassYous]

had a hand surgeon ask me to do a block on a small hand cause when he was just right there. i told him to do it.

But you get paid extra money if you block. He doesn't get anything. Also your blocks are presumably better.

 

[anbuitachi]

But you get paid extra money if you block. He doesn't get anything. Also your blocks are presumably better.

i do not get paid extra. im salaried. also the payer mix is either medicaid or uninsured, so in NY my department doesnt get paid for post op blocks either as far as i know

 

[GassYous]

i do not get paid extra. im salaried. also the payer mix is either medicaid or uninsured, so in NY my department doesnt get paid for post op blocks either as far as i know

I am sorry to hear that

 

[PlayToWin]

you do not get paid extra for eye blocks, as that is considered the anesthetic of choice vs a nerve block which is considered for post op pain relief.
I do blocks because it’s part of the OP center I work. Surgeons are bouncing between 2 rooms sometimes doing 20-40 cases per day. It’s like a convenience thing and we get to bill vs them hiring their own Crnas or Anesthesiologist.

 

[Shimmy8]

He wasn't at MEEI. Random ASC in western Mass. He resigned his license afterwards. Was in practice for 35 years. Anesthesiologist blamed for causing blindness in 5 cataract patients at Massachusetts clinic: 9 takeaways

It only takes one globe injury to ruin a career.

I was training in New England when this was made public…on my community hospital rotation where we learned how to do retrobulbar blocks! 😂😬

 

[lymphocyte]

Anyone here do eyes a lot? What are your thoughts on adding dexamethasone/dexmedetomidine to your mix? What is your mix?

I mainly subtenon and one of my colleagues raves about them... but I'm not sold on it given how foolproof the plain blocks can be.

Faster onset in high turnover lists seems to be the main benefit?

Our mix is half and half 0.75% bupivacaine + 2% lignocaine to 4mLs + 150IU hyaluronidase + 20 microg of Precedex. Warm.

Anecdotally, patients enjoy a denser and a longer block. They seem to have a pretty comfortable night post-op.

I work in your part of the world, and I have no clue why anaesthetists still do these. But I'm just a bitter ICU trainee doing too many eye lists 🤣

 

[GassYous]

Our mix is half and half 0.75% bupivacaine + 2% lignocaine to 4mLs + 150IU hyaluronidase + 20 microg of Precedex. Warm.

Anecdotally, patients enjoy a denser and a longer block. They seem to have a pretty comfortable night post-op.

I work in your part of the world, and I have no clue why anaesthetists still do these. But I'm just a bitter ICU trainee doing too many eye lists 🤣

Why would an icu trainee do any eyes at all??

 

[lymphocyte]

Why would an icu trainee do any eyes at all??

We do a year of anesthesiology come what may.

 

[woopedazz]

We do a year of anesthesiology come what may.

Pretty funny putting the ICU trainee on eyes lol. We run ours through obstetrics so they can help out on nights, but never something like eyes

 

[dhb]

But you get paid extra money if you block.

68% more

 

[jwk]

Absolutely pointless IMHO for anesthesiologists to be doing eye blocks. We abandoned doing them at least 15 years ago. If the surgeons really want them it's either

A) they do it themselves
B) they do it themselves with us providing a whiff of propofol sedation.

Virtually any cataract procedure can be done with local eye drops +/- sedation. Blocks totally unnecessary except for old school ophthalmologists that refuse to make the jump to topical only. You want speed? Topical clearly the way to go.

There is zero financial incentive for us to be doing eye blocks, and a small but significant risk to doing them. Better for the eye guys to screw it up than anesthesia.

 

[woopedazz]

Eyes are cash money in other regions of the world, there is significant incentive here.

 

[FiO2@21]

Are there even programs in the US with significant enough volume in these blocks anymore?

 

[nimbus]

Are there even programs in the US with significant enough volume in these blocks anymore?

One of the regional fellowships run by IAA in Connecticut appears to teach it.

 

[dhb]

One of the regional fellowships run by IAA in Connecticut appears to teach it.



View attachment 342345

Love the 60 surgeries before 3PM

 

[GassYous]

Love the 60 surgeries before 3PM

Would be great as an attending. Horrible as a fellow

 

[nimbus]

Love the 60 surgeries before 3PM

Would be great as an attending. Horrible as a fellow

Well the fellow probably gets pretty good at eye blocks.

 

[deleted697535]

Anyone here do eyes a lot? What are your thoughts on adding dexamethasone/dexmedetomidine to your mix? What is your mix?

I mainly subtenon and one of my colleagues raves about them... but I'm not sold on it given how foolproof the plain blocks can be.

Faster onset in high turnover lists seems to be the main benefit?

Haven't done eyes in yrs but I thought subtenons were the plain blocks?

 

[woopedazz]

Haven't done eyes in yrs but I thought subtenons were the plain blocks?

I will mainly use a "plain mix" of one or more of ropivacaine/bupivacaine/lignocaine depending on the goals of the block and what is available. Hyalase only if mandated by the department I'm in.

But this colleague uses adjuncts and I'm wondering if that's common.

 

[fadedrebel]

you do not get paid extra for eye blocks, as that is considered the anesthetic of choice vs a nerve block which is considered for post op pain relief.
I do blocks because it’s part of the OP center I work. Surgeons are bouncing between 2 rooms sometimes doing 20-40 cases per day. It’s like a convenience thing and we get to bill vs them hiring their own Crnas or Anesthesiologist.

This was my situation as well. Surgeons liked having us do the blocks in preop so they were fully blocked by the time they went for surgery. For both catarcts/retinas.
This was at a surgery center in TX.

 

[dantt]

Ophthalmology here. Blocks don't need to be done under U/S. If you're not comfortable doing it without U/S, have the surgeon do it. Block is using lidocaine/marcaine +/- hyaluronidase, sometimes patient is sedated with propofol, sometimes alfentenil.

 

[dantt]

But why? Why don't the ophthos just do the peribulbar block themselves? They're literally right there, operating on/in the eye. Seems weird to me that they'd need someone else to do the block.

Ophtho here. I do most of my own blocks. The main scenario where I want anesthesia to do blocks is if I have 2 rooms and the patient is able to be blocked and draped before I get in. If they have to wait for me to come in to do a time out for example, I might as well do the block myself.