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

Abstract

SummaryIn a single centre, randomised, double-blind study, 54 patients underwent intraocular surgery under peribulbar anaesthesia with either ropivacaine 1% or a mixture of bupivacaine 0.75% and lignocaine 2%, both with hyaluronidase 7.5 iu.ml ¹1 . There were no significant differences in volume of anaesthetic required, time to onset of block, peri-operative pain scores or frequency of adverse events between the ropivacaine group and the lignocaine and bupivacaine group.

Consent and anaesthetic risk

“…The incidence of postoperative ptosis at 24 h after surgery is reported to be up to 50%, with residual problems in 20% of patients at one month [234]. Between 8 and 70% of patients suffer from diplopia at 24 h after surgery, with wide variations due to the different local anaesthetics used [235,236].…”

Consent and anaesthetic risk

“…The incidence of postoperative ptosis at 24 h after surgery is reported to be up to 50%, with residual problems in 20% of patients at one month [234]. Between 8 and 70% of patients suffer from diplopia at 24 h after surgery, with wide variations due to the different local anaesthetics used [235, 236].…”

A comparison of two double‐injection techniques for peribulbar block analgesia: infero‐temporal plus supero‐medial vs. infero‐temporal plus medial‐percaruncular*

“…The observation in this study that relatively large volumes (approximately 13 ml) of injectate are injected initially, as compared with lower volumes (approximately 9 ml) in those studies promoting single‐injection techniques (9, 10), is intriguing. The difference may be attributable to different akinesia scoring systems, injection techniques, injectates and population differences, as our study population comprised Middle Eastern Arabs rather than Caucasians.…”

“…The design of the study was modeled on the usual practice at KKESH, where the need for rapid attainment of ocular akinesia is achieved by giving supplementary injections according to a standardized ocular akinesia scoring protocol every 5 min following the initial two injections. The double‐injection technique is still popularly practiced at KKESH, as elsewhere (3, 7), despite the risk that multiple peri‐ocular injections increase the likelihood of complications (8) and recommendations that alternative single‐injection techniques (9, 10) minimize this risk. Further, it is accepted in our hospital, as elsewhere, that globe akinesia is associated with adequate globe and conjunctival analgesia (3), and, accordingly, as elsewhere, akinesia is used in our clinical practice to monitor the onset of blocks and in research to compare the efficacies of injectates and injection techniques (3–5, 7, 9–11).…”