Background and Aims Literature is scarce regarding anesthetic management for treatment of retinopathy of prematurity (ROP). Retrospective analysis report that peribulbar block (PB) combined with general anesthesia (GA) seems safe in preterm infants.

Methods We report a case of a preterm infant submitted to bilateral PB for surgical treatment of ROP.

Results 2.8 kg, 41 weeks correct age male preterm infant was scheduled for elective vitreoretinal surgery due to stage IV ROP.

In preoperative assessment no supplement oxygen was needed and he presented anemia and gastroesophageal reflux. Monitorization included continuous electrocardiogram, two pulse oximeters, noninvasive arterial pressure, end tidal carbon dioxide, temperature and glycemia. GA and tracheal intubation were performed and bilateral PB was executed with single infratemporal injection 0.25 ml/kg/eye ropivacaine 0.375% with 30G needle (0.7 mL local anesthetic/eye). Maximum allowed concentration was considered (3 mg/kg).

Intraoperative course lasted 290 minutes and was uneventful, without further opioid requirements. Dexamethasone and paracetamol were administered. Neuromuscular blockage was reversed and infant successfully extubated and transferred to Neonatal Intensive Care Unit for 24 hours, following local protocol. No complications were reported or rescue analgesics were required.

Conclusions Premature infants present a challenge as they are more prone to perioperative cardiorespiratory complications.

PB has demonstrated effectiveness in reducing incidence of oculocardiac reflex, surgical bleeding, postoperative apnea and pain. GA complemented with bilateral PB achieved stable hemodynamics without additional opioid throughout surgery, indicating an acceptable quality of analgesia. Moreover, risk of postoperative apnea was reduced, as baby presented < 60 weeks correct age and anemia, two known risk factors in preterm infants.