Ocular evisceration-Ultrasound-guided Retrobulbar

Alright folks, I admit, this is the highly imperfect footage of a highly imperfect ultrasound-guided retro-bulbar-block. It was performed on an 80 year old, frail diabetic lady after she was intubated. Apart from her right cornea being a turbid, ulcer-ridden plaque she suffers from coronary heart disease and any other form of atherosclerosis. She was in constant discomfort from her eye over the last weeks and months so I asked myself how to save-guard her from phantom-pain after evisceration. I decided to give her this retrobulbar block and some ketamine over the course of the operation.
As for the block, obviously, there are legions of you “retro-bulbikers” out there who could easily out-perform me. Just forward your video and I shall gladly delete mine-wich I will anyway, once I get to do a better one. But maybe this post merits some remarks on my current use of the retro-bulbar block: I do them extremely rarely, because in daily business “no-snip-sub-Tenon’s” is my block of choice, with the occasional peribulbar block as a side-dish. I limit the use of RBBs almost completely to enucleation/evisceration/exenteration cases. That way I get to train the blocks without subjecting my patients to the risk of needling their bulbus. On this case I had a short discussion with the surgeon, wether to add a very small dose of epinephrine to the block, to limit bleeding during the procedure. I didn’t in the end. Any experiences from anyone out there? “Ground-control for major Tom…”
Aah, just a short ending remark on the movies: while in the first one, there are moments where you see the needle in-line, at the end of the second one you see the spread of local anesthesia intraconally. I know, not great, eh, but better done than perfect…. Next year in Jerusalem, I shall combine the two lucid moments into one movie and shall crown myself “senior-retrobulbologist” of the highest order!

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