Comparison of Bupivacaine With and Without Adrenalin and Mepivacaine With Adrenalin in Intraocular Surgery

Abstract

A comparative double-blind study has been made of 0.5 O/o bupivacaine (Marcainea) with adrenalin 1 :200 000, 0.5 O/o bupivacaine plain, and 2 O/o mepivacaine (CarbocaineB) with adrenalin 1 :200 000, in a series of 35 patients undergoing cataract and glaucoma surgery. The onset time of analgesia did not differ in the groups, but the onset of akinesia in orbicularis, and especially in the extraocular muscles, seemed longer in both bupivacaine groups. The duration of analgesia was about one and a half times as long, and that of akinesia about twice as long in the two bupivacaine groups as in the mepivacaine/adrenalin group. In the bupivacaine plain group an increased tendency towards conjunctival bleeding was observable during the operation; consequently, bupivacaine with adrenalin is preferable.In ocular surgery, 0.5 O/o bupivacaine with adrenalin offers a good choice of local analgesic agent when local anesthesia must last a long time. Due to its slow onset, the local blocks have to be administered at least 30 minutes before the surgery is begun.In intraocular operations, temporary paralysis of the orbicularis oculi and the extraocular muscles, together with blocking of the postganglionic fibres of the

Etidocaine in Retrobulbar Anaesthesia

“…The onset of anaesthesia of mepivacaine 1 O/O was rapid, which is in agreement with other studies of this agent (CastrCn 1963;Laaka et al 1972). The onset of anaesthesia after etidocaine 0.5 O/O and 1 O/O was comparable to that of mepivacaine ( Figs.…”

“…4) while in study B it was 330 min (Table IV, W . Thorburn, A.-M. Thorn-Alquist and H. Edstriim (Laaka et al 1972), and without adrenaline 300 min (Laaka et al 1972). With etidocaine 1 O/O without adrenaline we reached 420 min for mean postoperative analgesia (Table IV).…”

“…For example adrenaline markedly prolongs the duration of action of lidocaine (Lofstrom 1970b), an effect not seen, at least not to the same degree, with mepivacaine (Albert k Lijfstrom 1965). The duration of action of bupivacaine was not increased by the addition of adrenaline (Lofstrom et al 1970a;Moore et al 1970;Laaka et al 1972). T h e effect of site of administration is studied by e. g. DhunCr & Lewis (1966) who studied regional blood flow after injections of mepivacaine, lidocaine and bupivacaine with and without the addition of adrenaline.…”

“…Despite the difficulty of comparison caused by the methods used by different authors it is of interest to compare the present results with the durations rkporfed for some other anaesthetics. Mepivacaine 20/0 with adrenaline 195-222 min ( C a s t r h 1963), 217 inin(Laaka et al 1972). Lidocaine 2 O/O with adrenaline 190 min (CastrCn 1963).…”

Retrobulbar anesthesia with and without adrenaline in extracapsular cataract surgery

“…Vettese & Breslin (1985) found that admixture of adrenaline to bupivacaineAidocaine produced a more reliable akinesia in retrobulbar anesthesia. Long lasting pain relief is of value after intraocular surgery, as it reduces the risk of ocular damage due to squeezing of the lids in the vulnerable early postoperative period (Laaka et al 1972). Our study failed to show that the addition of adrenaline to lidocaine influenced akinesia or analgesia before and during surgery, but it resulted in a prolonged postoperative analgesia.…”