The impact of two different doses of Dexmedetomidine to Local Anesthetic Mixture on the quality of single injection Peribulbar Block in Vitreoretinal operations

Abstract

Objective: to evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations Design: A prospective, double-blinded and randomized study.Setting: carried out in operating room of our university hospital. Patients:The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017.Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 μgdexmedetomidine, and group III received5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 μg dexmedetomidine Measurements:The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction. Results:The onset of globe anesthesia was signifi cantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically signifi cant in group II and III in comparison with the group I .Conclusions: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/ hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.

Effect of adding dexmedetomidine to 0.75% ropivacaine in peribulbar block for vitreoretinal surgery

“…Our results show that the number of patients requiring an additional block was lower in the D25 and D50 groups but was not statistically significant. El Shmaa et al ,[ 17 ] noted a significant decrease in the need for additional injections when dexmedetomidine was added to PBB (Lidocaine/0.5% Levobupivacaine/hyaluronidase). Their control group had block success rate of 60%.…”

Commentary: Role of alpha-2 agonists in regional ophthalmic anaesthesia

“…Two recent studies have evaluated its efficacy and side-effect profile when used as an adjunct to peribulbar block during vitreoretinal surgery. [78] Ahmed et al [7] used 20 μg of dexmedetomidine along with lidocaine, bupivacaine and hyaluronidase. They found faster onset of anaesthesia, akinesia, increased duration of anaesthesia and increased patient sedation in comparison to a control group using normal saline.…”

“…They found faster onset of anaesthesia, akinesia, increased duration of anaesthesia and increased patient sedation in comparison to a control group using normal saline. EL-Shmaa et al [8] compared two doses of dexmedetomidine, 15 and 30 μg, as adjuvants to routine peribulbar anaesthetic agents. They also found similar results in terms of onset and duration of anaesthesia in the dexmedetomidine groups compared with the control group.…”

Commentary: Role of alpha-2 agonists in regional ophthalmic anesthesia

“…Two recent studies have evaluated its efficacy and side effect profile when used as an adjunct to peribulbar block during vitreoretinal surgery. [78] Ahmed et al . [7] used 20 μg of dexmedetomidine along with lidocaine, bupivacaine, and hyaluronidase.…”

“…EL-Shmaa et al . [8] compared two doses of dexmedetomidine – 15 and 30 μg – as adjuvants to routine peribulbar anesthetic agents. They also found similar results in terms of onset and duration of anesthesia in the dexmedetomidine groups compared with the control group.…”