Cataract surgery is the commonest ophthalmic surgical procedure and a local anaesthetic technique is usually preferred but the provision of anaesthesia in terms of skills and resources varies worldwide. Intraconal and extraconal blocks using needles are commonly used. The techniques are generally safe but although rare, serious sight- and life-threatening complications have occurred following the inappropriate placement of needles. Sub-Tenon's block was introduced as a safe alternative to needle techniques but complications have arisen following this block as well. Currently, there is no absolutely safe ophthalmic regional block. It is essential that those who are involved in the care of these patients have a thorough knowledge of the techniques used. This review article outlines the relevant anatomy, commonly used techniques and their safe performance and perioperative care.
Cataract Extraction ; Humans ; Nerve Block ; adverse effects ; methods ; Ophthalmologic Surgical Procedures

INTRODUCTIONA case is presented of a patient with severe and chronic pain in the orbital region, which was relieved by retrobulbar injection of absolute alcohol. The management of chronic pain in the orbital region has received little attention and the literature is reviewed.

CLINICAL PICTUREA 52-year-old man with adenoid cystic carcinoma of the maxillary sinus was suffering from severe pain, especially in the left orbital region. There was also pain from ocular exposure and compression caused by the tumour. Magnetic resonance imaging (MRI) revealed spread of tumour to both orbits, particularly on the left. Multiple debulking surgery and various treatment modalities offered no relief from his pain.

TREATMENTA single retrobulbar injection of 2 mL of absolute alcohol, was placed into the putative orbital apex.

OUTCOMEAs a consequence of the injection, he had complete resolution of his pain in the 6 months prior to his death.

DISCUSSIONRetrobulbar injection of alcohol offers effective pain relief in certain specific conditions characterised by chronic orbital pain when other treatments do not help.

CONCLUSIONWe have demonstrated that the retrobulbar technique still has a place in our armamentarium.

Analgesia ; Anti-Infective Agents, Local ; administration & dosage ; therapeutic use ; Carcinoma, Adenoid Cystic ; pathology ; Chronic Disease ; Ethanol ; administration & dosage ; therapeutic use ; Humans ; Injections ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Maxillary Sinus ; drug effects ; pathology ; Middle Aged ; Orbit ; drug effects ; physiopathology ; Pain ; drug therapy

PURPOSE: Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers. METHODS: The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis. RESULTS: The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o'clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied. CONCLUSION: An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.
Anal Canal ; Animals ; Cadaver ; Colostomy ; Humans ; Perineum ; Pudendal Nerve ; Pylorus ; Vagus Nerve

The present study was aimed to investigate behavioural and biochemical effects of chronic exposure of amplitude modulated and non-modulated microwave radiation on laboratory mice. Chronic microwave exposures were executed with 2.45 GHz of either modulated (power density, 0.029 mW/cm²; specific absorption rate, 0.019 W/Kg with sinusoidal modulation of 400 Hz) or nonmodulated continuous sinusoidal wave (power density, 0.033 mW/cm²; specific absorption rate, 0.023 W/Kg) for 2 hrs daily for 1 month. Mice subjected to non-modulated microwave exposure had significantly increased acetylcholinesterase activity and increased intracellular calcium and nitric oxide levels in the cerebral cortex and hippocampus, and also had increased glucose and corticosterone levels in blood compared to control mice. These non-modulated microwave-exposed mice exhibited anxiety-like and depression-like behaviours. In contrast, mice exposed to modulated microwave for the same period did not show such changes in concomitant biochemical and behavioural analyses. These results suggest that chronic non-modulated microwave, but not modulated microwave, radiation may cause anxiety-like and depression-like behaviours and calcium- and NO-related biochemical changes in the brain.
Absorption ; Acetylcholinesterase ; Animals ; Anxiety ; Brain* ; Calcium ; Cerebral Cortex ; Corticosterone ; Depression ; Glucose ; Hippocampus ; Mice* ; Microwaves* ; Nitric Oxide