1567: Curriculum Lesson 4: Anesthesia

In order to perform ocular surgery we need an appropriate level of anesthesia for both patient comfort and cooperation. For beginning surgeons this is typically a retro-bulbar injection, peri-bulbar injection, or sub-tenon’s injection. For more experienced surgeons, topical anesthesia (no injection) is more common. Note that the injection techniques give anesthesia and akinesia, however topical anesthesia (even if paired with intra-cameral medications), give only anesthesia while the eye can still move.

All of these techniques are commonly paired with systemic sedation in the USA, with intra-venous, sub-lingual, or oral medications from the benzodiazepine class. In some cases intra-venous opioids such as fentanyl or alfentanil are given for additional pain relief. The videos here show the techniques for giving these injections and I also go over my secret to ensure patient fixation with topical anesthesia even with minimal or no systemic sedation.

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