Use of Piritramide for Analgesia and Sedation during Peribulbar Nerve Block for Cataract Surgery

Abstract

Purpose: To investigate the effects of pre-block analgesia and sedation using piritramide on haemodynamic stability, endocrine stress response and patients’ pain perception. Methods: In a randomized, single-blinded, placebo-controlled study, 60 patients having cataract surgery with peribulbar block were randomly assigned into two groups: group A (n = 30) received 0.05 mg/kg piritramide (Dipidolor^®) intravenously; group B received normal saline intravenously prior to peribulbar block. Mean arterial pressure, heart rate, respiratory rate and pulse oximetry were recorded perioperatively. Pain from peribulbar block was assessed using a verbal analogue scale. Urinary excretion of vanillylmandelic acid was measured to assess the endocrine stress response. Using a questionnaire, patients assessed their anxiety and back pain before and during surgery. Results: Mean arterial pressure remained near baseline in group A. In group B, a significant increase in mean arterial pressure after peribulbar block was found (p < 0.001). In addition, a significant increase in urinary excretion of vanillylmandelic acid was found in group B (p = 0.013). Pain scores (p < 0.001), anxiety before nerve block (p = 0.02) and during surgery (p < 0.001) and back pain (p = 0.003) were significantly lower in group A. Conclusion: The presented study suggests that using piritramide for analgesia and sedation prior to peribulbar block produces haemodynamic stability and reduces pain perception and endocrine stress response.

Anaesthetic Management in Cataract Surgery

“…Lower doses of 0.25-0.5 μg/kg may be advised as needed (Rewari et al, 2002). Piritramide is another analgesic available in certain countries that has been found to be efficient against retrobulbar block-induced pain, hemodynamic changes and stress responses (Reinhardt et al, 2002). A combination of fentanyl with a major tranquilizing drug droperidol, which is available commercially as Innovar, induces anaesthesia/analgesia without complications when concurrently used with topical anaesthesia and facial nerve block in a large number of patients (Hodgkins et al, 1992).…”