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We present a case of a 44-year-old man that came to the clinic with exophthalmus and frontal headaches. TC and MRI showed a fronto-sphenoidal mass with extension to the cribiform plate involving the orbit and pushing the eyeball forward. The mass was completely excised through intranasal endoscopic surgery and it was found out to be a mucocele from concha bullosa.

To evaluate peroperative pain management using a flexible spinal anesthesia catheter introduced into the retrobulbar space which allows injections of local anesthetics for vitreoretinal surgery.Twenty-five patients who underwent vitreoretinal surgery receiving retrobulbar anesthesia with 3.5 ml ropivacaine 0.75%. After injection, a catheter with spinal needle 22G x 1 1/2 (40 x 0.7 mm) was introduced to the retrobulbar muscle cone. The needle was withdrawn and the catheter was fixed. When the patient started to feel pain (grade 3 or higher), 2 ml ropivacaine 0.75% was administrated through the catheter during surgery or 2 ml ropivacaine 0.2% in the postoperative period. The catheter was removed 24- 48h later.During surgery, 1 patient (4%) received a re-injection of 2 ml ropivacaine 0.75% because of pain. Three patients (12%) experienced pain of grade 3 or higher in the postoperative period and needed re-injection of 2 ml ropivacaine 0.2%. Re-injections were an effective method to achieve analgesia. Adverse effects were not noticed.The retrobulbar catheter technique is a procedure which allows multiple re-injections of local anesthetics; it provides adequate analgesia during surgery and rapid, effective and safe postoperative pain management.

espanolObjetivos: Evaluar el manejo del dolor peroperatorio en la cirugia vitreorretiniana, utilizando un cateter retrobulbar que permita reinyecciones de anestesicos locales. Metodos: Fueron incluidos en el estudio 25 pacientes, sometidos a cirugia vitreorretiniana, utilizando un cateter flexible introducido en el espacio intraconal, a traves de una aguja espinal 22 G 1 1/2 de 40x0,7 mm, con la que depositamos previamente 3,5 ml de ropivacaina 0,75% retrobulbares, dejando posteriormente el cateter fijado a piel. Ante la presencia de dolor (grado 3 o superior) se reinyectaron en el postoperatorio 2 ml de ropivacaina 0,2%, y 2 ml al 0,75% si el dolor acontecia intraoperatoriamente. El cateter se mantuvo entre 24 y 48 horas. Resultados: Un paciente (4%) manifesto moderado dolor intraoperatorio, que cedio tras la administracion de 2 ml de ropivacaina 0,75% a traves del cateter, y no ocasiono interrupcion de la cirugia. Tres pacientes (12%) precisaron una reinyeccion postoperatoria de 2 ml de ropivacaina 0,2% por dolor. Las reinyecciones aliviaron el dolor de forma inmediata (menos de 3 min). No se precisaron segundas reinyecciones, ni se detectaron complicaciones derivadas de la tecnica. Conclusiones: La cateterizacion del espacio retrobulbar permite la administracion fraccionada de anestesicos locales, aportando a la cirugia vitreorretiniana un adecuado soporte anestesico, asi como un control del dolor postoperatorio de forma inmediata, eficaz y segura. EnglishObjective: To evaluate peroperative pain management using a flexible spinal anesthesia catheter introduced into the retrobulbar space which allows injections of local anesthetics for vitreoretinal surgery. Methods: Twenty-five patients who underwent vitreoretinal surgery receiving retrobulbar anesthesia with 3.5 ml ropivacaine 0.75%. After injection, a catheter with spinal needle 22G x 1 1/2 (40 x 0.7 mm) was introduced to the retrobulbar muscle cone. The needle was withdrawn and the catheter was fixed. When the patient started to feel pain (grade 3 or higher), 2 ml ropivacaine 0.75% was administrated through the catheter during surgery or 2 ml ropivacaine 0.2% in the postoperative period. The catheter was removed 24-48h later. Results: During surgery, 1 patient (4%) received a re-injection of 2 ml ropivacaine 0.75% because of pain. Three patients (12%) experienced pain of grade 3 or higher in the postoperative period and needed re-injection of 2 ml ropivacaine 0.2%. Re-injections were an effective method to achieve analgesia. Adverse effects were not noticed. Conclusions: The retrobulbar catheter technique is a procedure which allows multiple re-injections of local anesthetics; it provides adequate analgesia during surgery and rapid, effective and safe postoperative pain management.

We present a case of a 44-year-old man that came to the clinic with exophthalmus and frontal headaches. TC and MRI showed a fronto-sphenoidal mass with extension to the cribiform plate involving the orbit and pushing the eyeball forward. The mass was completely excised through intranasal endoscopic surgery and it was found out to be a mucocele from concha bullosa.

To determine the work time used for out-patients seen in the ophthalmology out-patient clinic according to treatment for each diagnosis and examination guidelines. Another objective was to discover the diagnostic related outpatient demand as well as the time spent on each technique.We have designed a computer database system that includes examinations, treatments and medical services. Their duration was measured in a random sample of 127 ophthalmology outpatients in the General Hospital of Castellon. Sixty five of the patients had come to their first visit and 62 to the follow-up visits.A new patient spends a mean of 42 minutes and a follow-up patient spends a mean of 27 minutes. The most frequent diagnoses are retinal diseases (30%), cataract (18.6%), glaucoma (11.8%) and ocular motility disorders (11.8%). We present the mean times used by the physician in the ophthalmic techniques used in outpatients.We have modified the standard times of 30 minutes for the first visit and 15 minutes for the follow-up visit. Data on the work time used for all the ophthalmics techniques in our outpatient clinic are presented. This ophthalmology survey can be used for health care managers to establish theOutpatient Visit Groupsand health care plan administration to adapt the resources to the demand.