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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Peribulbar Anesthesia with Either 0.75% Ropivacaine or a 2% Lidocaine and 0.5% Bupivacaine Mixture for Vitreoretinal Surgery: A Double-Blinded Study

Luigi Gioia, MD^*, Edi Prandi, MD^*, Marco Codenotti, MD, Andrea Casati, MD^*, Guido Fanelli, MD^*, Tiziana Monica Torri, BS^*, Claudio Azzolini, MD, and Giorgio Torri, MD^*

Departments of *Anesthesiology and Ophthalmic Surgery, University of Milan, IRCCS H. San Raffaele, Milan, Italy

Address correspondence and reprint requests to Andrea Casati, MD, Department of Anesthesiology, IRCCS H. San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Address e-mail to casati.andrea{at}hsr.it

No study has evaluated the efficacy of ropivacaine in peribulbar block for ophthalmic surgery. The purpose of this prospective, randomized, double-blinded study was to compare ropivacaine and a lidocaine-bupivacaine mixture in peribulbar anesthesia. Sixty ASA physical status I or II patients scheduled for elective vitreoretinal surgery were randomized to receive a peribulbar block with 8 mL of either 0.75% ropivacaine (ropivacaine group, n = 30) or a 1:1 mixture of 2% plain lidocaine and 0.5% plain bupivacaine (lido-bupivacaine group, n = 30). Time required for onset of surgical anesthesia, quality of postoperative analgesia, incidence of side effects, and analgesic consumption were recorded. Surgical block was achieved after 8 ± 5 min in the lido-bupivacaine group and after 10 ± 5 min in the ropivacaine group (P = 0.23). A 3-mL supplemental injection 15 min after block placement was required in 6 patients in the lido-bupivacaine group (20%) and in 10 patients in the ropivacaine group (33%) due to inadequate motor block (P = 0.38). On Postoperative Day 1, 26 patients in the ropivacaine group (87%) reported no pain at the verbal rating score, compared with 18 patients in the lido-bupivacaine group (60%) (P = 0.005). We conclude that 0.75% ropivacaine may be a suitable choice when performing peribulbar anesthesia for vitreoretinal surgery.

Implications: Quick onset of block with prolonged postoperative analgesia is an important goal in regional anesthesia for ophthalmic surgery. Evaluating clinical properties of 0.75% ropivacaine and a 1:1 mixture of 2% lidocaine and 0.5% bupivacaine for peribulbar anesthesia, we demonstrated that ropivacaine has an onset similar to that of the lidocaine-bupivacaine mixture and provides a better quality of postoperative analgesia.

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