Comparing different fentanyl concentrations added to local anesthetic mixture in peribulbar block for cataract surgery

Background: The use of an adjuvant to local anesthetics in the peribulbar block may improve the block characteristics. This study aimed to evaluate the effect of the addition of either ketamine or fentanyl to local anesthetics in single injection peribulbar block on the quality of the block. Methods: The study included ninety adult patients presented for vitreoretinal surgeries. Patients were randomly allocated into three groups. All patients received peribulbar block with a local anesthetic mixture composed of 4 ml lidocaine 2% containing hyaluronidase, and 5 ml of plain bupivacaine 0.5% with an addition of either 1 ml of normal saline, 30 μg fentanyl, or 25 mg ketamine in Control group, Fentanyl group, and Ketamine group respectively. The measurements included the onset and duration of both anesthesia and akinesia with evaluation of intraocular pressure, postoperative pain score and need of analgesics. Results: As compared to control group, the use of either fentanyl or ketamine as local anesthetic adjuvant significantly fastened the onset of anesthesia (1.67 ± 1.21 min) (1.93 ± 1.36 min), prolonged the duration of lid akinesia (127.50 ± 22.20 min) (127.00 ± 22.19 min), increased the duration of globe akinesia (156.00 ± 28.02 min) (158.00 ± 31.18 min), minimized the time required to start surgery (6.57 ± 1.99 min) (6.57 ± 1.85 min), and increased the time for first request of postoperative analgesia (189.50 ± 34.92 min) (184.67 ± 35.37 min) (P < .05). However, neither fentanyl nor ketamine had a significant effect on the onset of lid or globe akinesia or the intraocular pressure (P > .05). Conclusion: Fentanyl or ketamine can be used as a local anesthetic adjuvant in the peribulbar block in patients presented for vitreoretinal surgeries as both of them improved the quality of the block without increasing intraocular pressure.

Section: Discussionsupporting

confidence: 92%

“…Calculation of sample size based on results of a previous similar study [15] revealed that at least 26 patients in each group were required to detect a significant difference of the onset of globe akinesia of one minute at α value of 0.05 and 90% power of the study. The statistical analysis was done by the use of SPSS.…”

Section: Statistical Analysis Of Datamentioning

confidence: 99%

Ketamine versus fentanyl as an adjuvant to local anesthetics in the peribulbar block for vitreoretinal surgeries: Randomized controlled study

Ahmed

Elmawy

Awd³

2018

“…The addition of clonidine provided longer duration of peribulbar block as compared to fentanyl. On the other hand, Kamel et al [17] concluded that a concentration of P2-3 lg/ml of fentanyl didn't affect neither the onset nor the duration of both lid and globe akinesia when added to local anesthetics for peribulbar block in patients undergoing cataract surgery. They stated that this concentration only improved the quality of postoper- Fig.…”

Section: Discussionmentioning

confidence: 99%

Fentanyl versus magnesium sulphate as adjuvant to peribulbar anesthesia in cataract surgery

Elyazed

Mostafa

2017

Background and Objectives: Fentanyl or magnesium sulphate may improve the quality of peribulbar block. We compared the effects of adding either fentanyl or magnesium sulphate to peribulbar block in patients undergoing cataract surgery on the quality of globe akinesia. Methods: 90 adult patients undergoing cataract surgery were randomly allocated into three groups. Peribulbar block was performed by a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, hyaluronidase 150 IU diluted in normal saline to a total volume of 10 ml in control group. 20 lg fentanyl and 50 mg magnesium sulphate (10%) were added to the same mixture in fentanyl and magnesium groups respectively. Onset and duration of lid and globe akinesia, adequate time to start surgery and duration of postoperative analgesia were recorded. Results: Addition of fentanyl significantly enhanced the onset of lid (1.54 ± 0.43 min) and globe akinesia (2.19 ± 0.75 min) as well as adequate time to start surgery (6.23 ± 1.8 min) compared to both control (P < 0.05) and magnesium sulphate (P < 0.05) groups while the comparison between control and magnesium sulphate groups was statistically insignificant (P > 0.05). Time of first analgesic request was significantly prolonged in both fentanyl and magnesium sulphate groups compared to the control group (P < 0.05). Conclusions: Addition of fentanyl (2 lg/ml) or magnesium sulphate (50 mg) to peribulbar block in patients undergoing cataract surgery equally prolongs the duration of postoperative analgesia. In addition to this effect, fentanyl fastens the onset lid and globe akinesia and provides better akinesia score.

“…Several studies have compared the effect of adding different types of additives to improve the quality of block in ophthalmic local anesthesia with varying results [4][5][6][7][8] Adding neuromuscular blockers to the local anesthetic does not affect analgesia but induces akinesia in extraocular muscles which helps optimize the setting for ophthalmic surgery. The dose of rocuronium chosen in this study was less than one-tenth the dose administered intravenously for clinical neuromuscular blockade.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has the disadvantages of a slow onset of orbital akinesia [2] and the frequent need for block supplementation [3]. To overcome these limitations, many adjuvant drugs such as adrenaline, sodium bicarbonate, hyaluronidase, clonidine, and opioids [4][5][6][7][8] have been added to the local anesthetic mixture used for peribulbar block to augment its efficacy and hasten its speed of onset; however, their effects have been variable. Neuromuscular blocking drugs, such as vecuronium [9] and atracurium [10], have also been added to the local anesthetic mixture and have been shown to improve the quality of peribulbar anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Rocuronium versus dexmedetomidine as an adjuvant to local anesthetics in peribulbar block: A double blind randomized placebo controlled study

Bakr

Abdelaziz

2017

a b s t r a c tObjective: To compare the use of rocuronium with that of dexmedetomidine as an adjuvant to the local anesthetic mixture in peribulbar anesthesia for cataract surgery. Design: A double blind, prospective, randomized controlled study. Methods: Ninety patients with cataract in the age group 18-80 years of American Society of Anesthesiologists (ASA) physical status I-III scheduled for elective cataract surgery under regional anesthesia were randomly divided into three groups; Group C (control) received peribulbar anesthesia using a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 1 ml normal saline. Group R received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 0.06 mg/kg rocuronium (maximum 5 mg) in 1 ml saline.Group D received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and dexmedetomidine 50 lg (1 ml). Patients were assessed for onset and duration of corneal anesthesia and globe akinesia, postoperative pain using visual analog score (VAS), intraocular pressure (IOP), and sedation level using modified Ramsay sedation score (RSS). Patient and surgeon satisfaction score were also assessed. Results: Corneal anesthesia was achieved more rapidly in groups D and R than group C (P < 0.01). Akinesia was achieved more rapidly in the group R than both group D and group C. Akinesia was achieved more rapidly in group D than the control group. Intraocular Pressure was significantly lower in group D compared to both the control group and group R. Ramsay sedation score was significantly higher in group D compared to both the control group and D. Patient and surgeon satisfaction was significantly higher in group R and D compared to the control group. Conclusion: Adding 5 mg rocuronium to local anesthetic mixture provides more rapid onset of corneal and globe akinesia than 50 lg dexmedetomidine. Adding dexmedetomidine decreases IOP and provides sedation.