Background: Retrobulbar block is a local anesthetic technique widely
used for intraocular surgery. Although retrobulbar anesthesia is
considered to be relatively safe, a number of serious adverse events
have been reported. To our knowledge, immediate onset of generalized
seizures with contralateral hemiparesis after retrobulbar anesthesia has
not been reported.
Case presentation: A 62-year-old Caucasian healthy male with a right eye
retinal detachment was admitted for pars plana vitrectomy. During
retrobulbar anesthesia with ropivacaine and before needle withdrawal,
the patient developed twitching of the face which rapidly progressed to
generalized tonic-clonic seizures. Arterial oxygen saturation decreased
to 75 %. Chin lift was performed and 100 % oxygen was administrated
via face mask, which increased saturation to 99 %. Midazolam 2 mg was
administrated intravenously to control seizures. After cessation of
seizures, left-sided hemiparesis was evident. Brain computed tomography
and electroencephalogram were normal 3 h later. The patient underwent
pars plana vitrectomy under general anesthesia 4 days later.
Conclusion: Serious complications of local anesthesia for ophthalmic
surgery are uncommon. We present a case in which generalized
tonic-clonic seizures developed during retrobulbar anesthesia, followed
by transient contralateral hemiparesis. The early onset of seizures
indicated intra-arterial injection of the anesthetic. Our case suggested
the need for close monitoring during the performance of retrobulbar
anesthesia and the presence of well-trained personnel for early
recognition and immediate management of the complications
