"RETROBULBAR VERSUS PERIBULBAR ANESTHESIA IN ANTERIOR SEGMENT OPHTHALMIC SURGERY: A NARRATIVE LITERATURE REVIEW"

Abstract

Purpose: To provide a comprehensive narrative review of published literature comparing retrobulbar and peribulbar anesthesia techniques in elective anterior segment ophthalmic surgeries, focusing on onset of block, globe akinesia, patient comfort, and safety profiles. Methods: We conducted a structured literature search in PubMed, Embase, and Cochrane Library for English-language articles from January 2000 to June 2025. Keywords included "retrobulbar anesthesia," "peribulbar anesthesia," "ocular block," and "anterior segment surgery." Clinical trials, case series, and expert opinion articles were included. Results: Fifty-two relevant articles were identified: 18 randomized controlled trials, 14 observational studies, 12 case series, and 8 narrative reviews or expert commentaries. Across studies, retrobulbar blocks consistently demonstrated faster onset (mean range 1.8–3.0 minutes) and higher rates of complete akinesia at 5 minutes (85–98%) compared to peribulbar blocks (onset 3.5–5.5 minutes; akinesia 70–88%). Patient-reported pain scores were modestly lower with retrobulbar; minor complications (e.g., chemosis, subconjunctival hemorrhage) varied by study design, while serious adverse events (e.g., globe perforation, optic neuropathy) were rare in both techniques. Conclusions: Retrobulbar anesthesia offers more rapid and reliable akinesia with comparable safety to peribulbar techniques, though both methods remain widely practiced. Operator experience and institutional protocols influence block choice. Future prospective registries and standardized outcome reporting are needed to refine best practices.