Staggered sub-Tenon's blocks: a novel anesthetic approach for bilateral strabismus surgery.

Bilateral strabismus surgery is usually performed under general anesthesia. However, sometimes general anesthesia is not in the best interest of patients presenting with advanced multiple comorbidities. These patients are best treated with local anesthesia instead. However, the bilateral nature of the surgery becomes an issue because bilateral akinetic needle blocks for ophthalmic surgery have not been described before. This article describes a novel approach for bilateral eye surgery in three patients who were at high risk from general anesthesia but needed to have the surgery performed in the same sitting. Staggered blunt needle sub-Tenon's blocks were chosen over sharp needle akinetic extraconal peribulbar or intraconal retrobulbar blocks on account of their predictability, relative safety, and efficacy. The potential systemic complications of bilateral injections were minimized by staggering the blocks. This technique may be an option for high-risk patients who are not candidates for general anesthesia but require bilateral ophthalmic surgery performed in a single surgical episode.