Comparison of pH-Adjusted Bupivacaine 0.75% and a Mixture of Bupivacaine 0.75% and Lidocaine 2%, Both with Hyaluronidase, in Day-Case Cataract Surgery Under Regional Anesthesia

Abstract

Alkalinized bupivacaine 0.75% (pH 6.8) and a mixture (1:1) of bupivacaine 0.75% and lidocaine 2%, both with hyaluronidase, were compared in regional ophthalmic anesthesia for day-case cataract surgery. Eighty-two patients were randomized into two groups (n = 39 and 43) to receive one of the two solutions in a double-blind manner. Two intraorbital injections were administered initially: an inferolateral intraconal injection (3 mL) and a medial extraconal injection (3.5 mL). The progress of lid and globe akinesia was examined every 2.5 min up to 25 min and postoperatively. The block was supplemented at 10 and 20 min, if needed. Significantly better globe akinesia was achieved with the bupivacaine-lidocaine mixture; the patients who had received alkalinized bupivacaine needed additional injections significantly more often at 10 and 20 min. In lid akinesia, the onset time and recovery were similar in the two groups. One patient in the alkalinized bupivacaine group felt intraoperative pain, and eight patients in the bupivacaine-lidocaine group and seven in the alkalinized bupivacaine group sensed pain postoperatively from corticosteroid and antibiotic injections. Seventy percent of the pH-adjusted bupivacaine group and 8% of the lidocaine-bupivacaine group had diplopia the day after surgery. Of the two local anesthetic mixtures studied, lidocaine (2%) with bupivacaine (0.75%) provided regional ophthalmic anesthesia of better quality.

Alkalinized lidocaine and bupivacaine with hyaluronidase for sub-Tenon's ophthalmic block

“…6 Considering these known facts, a number of clinical trials for ocular procedures using retrobulbar or peribulbar techniques have been conducted with a variety of LA combinations and strengths, together with hyaluronidase and pH adjustment, to determine optimum mixtures. [4][5][6][7][8]17 In our study, we could not find any difference in the time to onset and time to full akinesia between the LBH-pH and LBH groups ( Table 2). This finding does not agree with the results obtained using other block techniques.…”

A comparison of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lignocaine for peribulbar anaesthesia

“…We found similar rates of diplopia the day after surgery in the two groups (26% in the ropivacaine group and 30% in the bupivacaine/lignocaine group). The incidence for ropivacaine is intermediate between that reported for bupivacaine 0.75% alone (70%) and the 8% incidence with lignocaine 2% and bupivacaine 0.75% reported in one series [21]. It is not known whether a weaker concentration of ropivacaine would provide adequate akinesia for surgery without such a high incidence of diplopia.…”

Comparison of 0.75% levobupivacaine with 0.75% racemic bupivacaine for peribulbar anaesthesia

“…On direct questioning 40% of group L and 52% of group B reported double vision when the eye shield was removed the morning after surgery. Sarvela et al reported that 70% of patients receiving 0.75% bupivacaine for retro/peribulbar anaesthesia experienced diplopia the following day, whereas a mixture of 0.75% bupivacaine and 2% lignocaine resulted in a diplopia rate of 8% [21]. Prolonged diplopia represents a significant risk to elderly patients who may already have impaired mobility.…”