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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Lidocaine Plus Ropivacaine Versus Lidocaine Plus Bupivacaine for Peribulbar Anesthesia by Single Medial Injection

Thierry Gillart, MD^*, Philippe Barrau, MD^*, Jean E. Bazin, MD^*, Ghislaine Roche, MD^*, Frederic Chiambaretta, MD, and Pierre Schoeffler, MD^*

Departments of *Anesthesiology and Ophthalmology, Centre Hospitalier Universitaire, Clermont-Ferrand, France

Address correspondence and reprint requests to T. Gillart, MD, Département d’Anesthésie-Réanimation, Centre Hospitalier Universitaire, 63003 Clermont-Ferrand, France.

This study was designed to compare the effects of ropivacaine and bupivacaine, each combined with lidocaine, during peribulbar anesthesia by single medial injection for cataract surgery. One hundred patients were included and randomly divided into two groups of 50, given a mixture of 50% bupivacaine (0.5%) and 50% lidocaine (2%) or 50% ropivacaine (1%) and 50% lidocaine (2%), and 25 U hyaluronidase per mL with each combination. After the first injection, patients given ropivacaine exhibited significantly better akinesia than those given bupivacaine, and significantly fewer were reinjected (19/50 vs 31/50). Among the patients reinjected, peroperative akinesia and analgesia proved satisfactory in both groups. We observed three cases of diplopia caused by retraction of the internal rectus muscle and two cases of moderate ptosis after superonasal reinjection. Hemodynamic profiles were similar in the two groups, and no major side effects were noted during the observation. One percent ropivacaine may be a more appropriate agent than 0.5% bupivacaine for peribulbar anesthesia by single medial injection.

Implications: One percent ropivacaine may be a more appropriate agent than 0.5% bupivacaine for peribulbar anesthesia by single medial injection. Combined with lidocaine, it provides better akinesia and similar analgesia.

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				D. K. Woodward, A. T. S. Leung, M. W. I. Tse, R. W. K. Law, D. S. C. Lam, and W. D. Ngan Kee Peribulbar anaesthesia with 1% ropivacaine and hyaluronidase 300 IU ml-1: comparison with 0.5%bupivacaine/2% lidocaine and hyaluronidase 50 IU ml-1 Br. J. Anaesth., October 1, 2000; 85(4): 618 - 620. [Abstract] [Full Text] [PDF]