We prospectively studied the efficacy of peribulbar anesthesia in 76 consecutive patients who underwent vitreoretinal surgery. The mean duration of anesthesia was 124.74 +/- 50.17 minutes, and the mean duration of akinesia, 151.5 +/- 54.45 minutes. Adequate anesthesia and akinesia, independent of the duration of surgery, was obtained in 26 of 33 (78.8%) patients who underwent vitrectomy; 9 of 32 (28.1%) who underwent scleral buckling; and 2 of 11 (18.2%) who underwent vitrectomy combined with scleral buckling. In all, topical and systemic supplementation of drugs for inadequate anesthesia or akinesia allowed 32 of the 33 (97%) vitrectomies, 30 of the 32 (94%) scleral buckling procedures, and all 11 of the combined surgeries to be completed as planned. Three (4%) patients vomited, moved, or were restless, resulting in an operative complication or postponement of surgery. Fifty-eight (76%) said they would desire similar anesthesia if subsequent surgery was needed in the same or fellow eye. We conclude that peribulbar anesthesia should be considered primarily for patients requiring vitreous surgery alone, and as an alternative for patients requiring scleral buckling or combined surgery for whom general anesthesia is contraindicated.