Subtenons Block
Clinical Procedure
 
Aliases:
Eye block

Topic aliases are alternate phrasings for a particular topic.


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Acceptable procedure to perform in antocoagulated patients as the risk of retro-orbital haematoma is less than in a peribulbar block.

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Conjunctival haemorrhage is common in subtenons blocks (compared to peribulbar blocks) and, although not clinically significant, can be cosmetically undesirable.

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Check globe ultrasound. Ensure axial length <25mm. Length greater than this increases likelihood of staphyloma and risk of globe perforation #ref

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Consent, IV access, and pulse oximetry placed prior to performing block

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NYSORA refl.in/5t

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Apply topical anesthetic drops and the povidine iodine prep around the orbit (larger area than the fenestration in the drape) and into the eye. Place fenestrated drape. Place the eye speculum (bottom lid first). Have patient look upwards outwards. Non-toothed (moorfield) forceps to grasp conjunctiva medially, 5-10mm from limbus) Make incision in inferonasal portion of the conjunctiva and Tenon's capsule. Blunt dissect to open the space, hold hole open with forceps. Pass blunt curved cannula gently into subtenon's space following the curve of globe. Inject 3-5ml LA stopping if patient complains of severe discomfort (intraorbital injection) or globe projects forward (suggests sufficient volume). Tape eyelids shut and place gentle manual pressure for 30secs. Assess for akinesia after 5min.

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Preparing local anaesthetic solution (sterile):
In 10ml syringe dilute 1500iu hyalase into 6ml Nsaline to give 250iu/ml.
Prepare x number 1ml syringes.
Take 0.3ml of the dilute hyalase solution (75i.u.) into each insulin syringe.

For each block:
Scrub.
Draw up 5ml of desired local anaesthetic.
Ask assistant to inject the 0.3ml dilute hyalase into the 5ml solution.
This gives 15u/ml hyalase.

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Tape lids closed after block to prevent corneal abrasion from gauze/padding

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May 18, 2011
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