Oculocardiac Reflex During Peribulbar Block: A Case Emphasizing the Role of Monitoring in Early Recognition

The oculocardiac reflex is a well-recognized autonomic phenomenon characterized by bradycardia in response to stimulation of ocular structures. It is most frequently encountered during strabismus surgery but may also occur during regional anesthesia techniques such as peribulbar block. We describe the case of a 64-year-old woman with no known comorbidities who developed sudden bradycardia during administration of a peribulbar block for cataract surgery. Following injection of 3 mL of 2% lignocaine with adrenaline (1:200,000) combined with hyaluronidase, a rapid decrease in heart rate (HR) was observed. The injection was immediately discontinued, and the patient was closely monitored. Although atropine was kept ready, it was not administered, as the HR returned spontaneously to baseline within 30 seconds. After confirming hemodynamic stability and adequacy of the block, surgery was completed uneventfully. This case highlights the importance of continuous monitoring and preparedness during a peribulbar block, even in routine clinical settings.