Reactions 1012 - 31 Jul 2004

SBupivacaine/lidocaine

Diplopia: 5 case reportsTwo men and three women underwent cataract surgery,

receiving peribulbar anaesthesia with 5–10mL of a 50:50mixture of 0.5% bupivacaine and 2% lidocaine. The next day,they developed diplopia, with rectus muscle paresis confirmedby a Lancaster test in four of the five patients.

A 55-year-old man developed paresis of his right inferiorrectus muscle, with vertical ophthalmoplegia; an MRI scan ofthe orbit was normal. A 78-year-old woman developed paresisof her right lateral rectus muscle, with horizontalophthalmoplegia. An MRI scan showed a T2 hyperintensitysignal and swelling of the right lateral rectus muscle,consistent with oedema. A 74-year-old woman developedparesis of her left lateral rectus muscle, with horizontalophthalmoplegia. An MRI scan showed a T2 hyperintensitysignal and swelling of the left lateral rectus muscle; MRIfindings resolved 5 weeks later. A 54-year-old womandeveloped paresis of her left inferior rectus muscle, withvertical ophthalmoplegia. An MRI scan showed a mild T2hyperintensity signal of the left inferior rectus muscle,consistent with inflammatory oedema. An 80-year-old mandeveloped paresis of his right lateral rectus muscle, withhorizontal ophthalmoplegia. An MRI scan showed a T2hyperintensity signal and swelling of the right lateral rectusmuscle, consisted with oedema.

Diplopia persisted in all five patients and correction, eitherwith a prism or with surgery, was required.

Author comment: "Post-anaesthetic diplopia is, in mostcases, probably a result of direct myotoxicity of an accidentali.m. injection of local anaesthetics."Taylor G, et al. Early exploration of diplopia with magnetic resonance imagingafter peribulbar anaesthesia. British Journal of Anaesthesia 92: 899-901, No. 6, Jun2004 - France 800981711

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Reactions 31 Jul 2004 No. 10120114-9954/10/1012-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved