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Editor,—Peribulbar blockade is frequently used for anaesthesia in ophthalmic surgery. Owing to its short onset time and low incidence of cardiac and central nervous system toxicity, the local anaesthetic prilocaine is a popular choice for peribulbar blockade. Prilocaine is, however, the most potent methaemoglobin forming local anaesthetic. We report a case of prilocaine induced methaemoglobinaemia after peribulbar blockade for ophthalmic surgery.
A 27 year old Romanian woman presented with a detached retina requiring surgical repair. Her medical history was significant for insulin dependent diabetes mellitus complicated by chronic renal failure, anaemia, and diabetic retinopathy. Her daily medication included captopril 25 mg, verapamil 240 mg, isosorbide dinitrate 40 mg, and frusemide 40 mg. A mixture of prilocaine 80 mg, bupivacaine 30 mg, hyaluronidase, and naphazoline was used to perform a peribulbar anaesthesia. Vital signs at the beginning …