الفهرس 
HISTORICAL PERSPECTIVESOnly 14 pages are availabe for public view
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Abstract
The goals of anaesthesia in outpatient cataract surgery are to maintain the patient’s safety and comfort, anaesthetize the ocular tissues properly, and, in more complicated cases, achieve akinesia while maintaining normal intraocular tissue and orbital pressures. for more than one decade anaesthesiologists used to use traditional methods in regional block in ophthalmic surgeries peribulbar, retrobulbar, sub-tenon, facial nerve block, isolated nerve block such as supratrochlear nerve, supraorbital nerve, frontal nerve, frontal nerve, nasociliary nerve and infraorbital nerve block .
But all these techniques are invasive techniques the needle is used to perform it and usually associated with complications . Which include: Systemic complications which may be caused by; anaesthetic toxicity associated with overdose or intravascular injection, allergic reactions occurring more ’with the ester group of local anaesthetics and vasovagal reactions. Complications related to the local anaesthetic agents and technique used such as subconjunctival oedema (chemosis), bruising (ecchymosis), globe perforation, intradural injection, retrobulbar haematoma, amaurosis, optic nerve atrophy, penetration of the optic nerve sheath, oculocardiac reflex, myotoxicity, central retinal artery occlusion respiratory arrest, and grand malseizures .
So it is essential that those who are involved in the care of these patients have a thorough knowledge of the techniques used, safe practice, possible complications and their management.
Because of all these complications associated with traditional methods in regional block in ophthalmic surgeries the transition to recent methods in regional block in ophthalmic surgeries which are Topical anaesthesia, Deep topical anaesthesia, Subconjuctival anaesthesia, Intracameral anaesthesia. These new methods are simple techniques with no risk associated with complication of needle injection. Visual recovery is rapid these modalities augments post operative comfort by eliminating the need for patching the eye after surgery so they are big advantage to those monocular patients
The recent methods require the full cooperation of the patient therefore the establishment of a good anaesthetist-patient relationship is very important.
Preoperative patient preparation includes the psychological preparation, the preoperative assessment, review of preoperative tests, optimization of medical conditions, adequate preoperative fasting, appropriate premedication, and the explanation of anaesthetic risk to patients .
The commonly used local anaesthetics in ophthalmic surgery are amide-linked agents e.g. lidocaine, mepivacaine and bupivacaine. The recently introduced drugs are levobupivacaine, etidocaine hydrochloride, ropivacaine and articaine. Mixing local anaesthetics is preferable since a long acting but slow-onset agent when mixed with a fast-onset shorter acting agent will produce the combined advantages incorporating the Properties of its constituent parts that is fast onset, long action and excellent postoperative analgesia. Adjuvant drugs added to local anaesthetics such as opioids. clonidine, epinephrine, hyaluronidase sodium bicarbonate muscle relaxants will improve analgesic effect, prolong duration and help spread of the local anaesthetic agent.