Efficacy and safety of retrobulbar blockade with ropivacaine during selective intraarterial chemotherapy in children with retinoblastoma. Article

Abstract

Background. The goal of treatment of retinoblastoma is not only the preservation of life and vision, but also the minimization of systemic complications, a cosmetic defect, which is achieved through the development of selective intraarterial chemotherapy (SIACT). Repeated conduction of the SIACT at the time of catheterization a. ophtalmica is accompanied by cardio-respiratory disorders (CRD). Objectives. We analyze the effectiveness and safety of retrobulbar blockade with a 0.,5 % solution of ropivacaine to prevent or reduce CRD. Materials and methods. The study included patients from the Blokhin National Medical Research Center of Oncology with retinoblastoma under conditions of general anesthesia in 2017-2018 SIACT procedures were performed (n = 267). 83 patients were primary. 83 % of them had a mild and moderate degree of cardio-respiratory disorders during the second SIACT procedure, 17 % of patients who were included in the study developed marked CRD (n = 14), for the prevention of which, during the third procedure of SIACT was performed retrobulbar blockade (RBB). Results. 4 (28.57 %) patients after retrobulbar blockade did not develop CRD in the third SIACT procedure, in 5 (35.7 %) patients after performing RBB, CRD symptoms decreased to moderate and in 5 (35.7 %) mild expressiveness. After the RBB, there was a lesser increase in airway resistance during inhalation of P_insp 25.4 ± 7.4, versus 33.8 ± 3.2 with OA and more stable hemodynamics. When conducting retrobulbar blockade with a solution of ropivacaine 0.5 % with a volume of up to 1.5 ml, no complications were observed in children with retinoblastoma. Conclusion. In our experience, pronounced cardio-respiratory complications are often observed during repeated sessions of SIACT in children with retinoblastoma and can be potentially life-threatening. Using of retrobulbar blockade with severe CRD may reduce the frequency and degree of development of respiratory disorders and is accompanied by greater hemodynamic stability.