Technique for Retrobulbar Anesthetic Injection for Eye Surgery

To perform a safe cataract surgery and to keep the patient comfortable and pain-free, we need to give a sufficient level of anesthesia. For beginning surgeons, giving a retrobulbar injection of anesthetic is a good way to achieve both anesthesia and akinesia. For experienced cataract surgeons, using a combination of topical anesthesia and intra-cameral anesthesia tends to work the best. I favor topical tetracaine eye drops combined with preservative-free dilute (1% or less) lidocaine given in the anterior chamber. For a resident who is starting to learn cataract surgery, a higher level of anesthesia such as a retrobulbar block should be given. The agents used are typically lidocaine 1% (Xylocaine), bupivicaine %(Marcaine), or a combination of the two. The lidocaine tends to start working faster and lasts for a shorter period of time compared to the bupivicaine which can last for many hours more. The anesthetic is drawn into a 5 or 10 cc syringe and an Atkinson retrobulbar needle is used. T