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September 1985

Brain-stem Anesthesia After Retrobulbar Block

Arch Ophthalmol. 1985;103(9):1278-1282. doi:10.1001/archopht.1985.01050090030017

To the Editor.  —The occurrence of accidental brain-stem anesthesia following retrobulbar block is unusual. Symptoms of this life-threatening complication have been described previously1-5 and also have been reported after stellate ganglion6 and extraoral trigeminal blocks.7 An experimental study by Drysdale8 indicated that access to the subarachnoid space may be gained via the subdural space of the optic nerve posterior to the chiasm, then into the subdural space surrounding the pons and midbrain. Lombardi9 reported the presence of subdural contrast medium in intracranial subdural spaces following retrobulbar injections for orbitography in three of 150 patients. A case of suspected brain-stem anesthesia following retrobulbar block is described herein.

Report of a Case.  —A healthy 43-year-old man (weight, 105 kg; height, 180 cm) was scheduled for a scleral buckling procedure for retinal detachment in his right eye. Results of the physical examination were otherwise normal, as were the