Blocks for ophthalmic surgery achieve two purposes: anesthesia and akinesia. There are two main methods of administering blocks. One is with a needle block (retrobulbar block) and the other is with a sub-Tenon’s block. Both ultimately deliver anesthetic to the retrobulbar space but sub-Tenon’s blocks, while potentially slower to achieve their maximum effect, are much safer, significantly decreasing the risk of retrobulbar hemorrhage, globe perforation and inadvertent injection of anesthetic into the subarachnoid space, which can result in potentially life-threatening spinal anesthesia. Some surgeons only perform sub-Tenon’s blocks in higher-risk situations like patients who are anticoagulated or those with long axial lengths. Other surgeons routinely perform sub-Tenon’s blocks on all their cases. In today’s episode, guest surgeon Dr. Omar Shakir shares with us a series of examples of sub-Tenon’s blocks performed for patients undergoing surgery in an office-based surgery setting. At the end of the case we will review some tips for successful administration of sub-Tenon’s blocks as well as some of the risks and downsides.
