Anesthesia with Peribulbar Block: Lidocaine-Bupivacaine vs Lidocaine-Bupivacaine-Fentanyl

Abstract

In the daily practice of ophthalmologic surgery, locoregional anesthesia is predominantly used for cataract surgery. The use of retrobulbar lidocaine was first described in 1885 by Herman Knapp [1] to perform the enucleation of a patient wounded in war; is not until the mid-1950 [2] when retrobulbar block is popularized. AbstractIntroduction: Ophthalmological procedures such as cataract extraction can be carried out with a Peribulbar Block (PBB). The advantages of this anesthetic technique include a lower incidence of coughing, unwanted movements and emesis during awakening, in addition to providing adequate postoperative analgesia.We observed that the use of fentanyl citrate by peribulbar route, when administered with a local anesthetic, shortens the anesthetic latency, does not interfere with the degree of akinesia and provides greater postoperative analgesia. The combined use of local anesthetics and fentanyl citrate in ophthalmic surgery offers great benefits for the patient, also allowing the surgeon an adequate surgical field. We observed in ophthalmic surgery with regional anesthesia that the peribulbar use of fentanyl citrate is an alternative that provides a greater intraoperative and postoperative analgesia when combined with local anesthetics.Objective: Demonstrate that the lidocaine-bupivacaine-fentanyl combination is better than the lidocaine-bupivacaine combination, since the former shortens the latency time of Peribulbar Block (PBB), produces the same degree of akinesia of the eyeball and provides longer postoperative analgesia time. Conclusion:The use of fentanyl citrate peribulbar shortens the latency time, does not interfere with the degree of ocular akinesia and provides better postoperative analgesia, so this combination of anesthetics may be a good alternative for cataract ophthalmic surgery under regional anesthesia.

Assessing The Efficacy of Single Inferomedial Peribulbar Injection in Lacrimal Intubation Surgery in Adult Patients: A Randomized Clinical Trial

“…Satisfactory anesthesia plays a crucial role in the success of ophthalmologic surgeries. The key requirements of any regional anesthetic block are patient comfort, safety, and effectiveness (12) .…”

The Effect of Adding Fentanyl to Peribulbar Block on Muscle Traction during Squint and Buckle Surgeries in Adult Patients: A Randomized Controlled Trial

“…Wulff et al (27) added fentanyl to the local anesthetics of peribulbar block in 70 adult cataract patients. The drug had favorable outcomes as shortening of the latency of the anesthetic and providing greater postoperative analgesia without interfering with the degree of akinesia.…”

“…Fentanyl has been added to local anesthetics used for regional anesthesia to improve analgesia (19)(20)(21)(22)(23)(24) . This practice has been taken to reduce complications of systemic opioids, for example cardiorespiratory depression, drowsiness, and postoperative nausea and vomiting (11,(25)(26)(27) .…”

Comparing 0.75% Ropivacaine and 0.5% Levobupivacaine For Peribulbar Blockade In Vitrectomy Surgery Towards Intraocular Pressure

“…Anesthesia for vitreoretinal surgery is a challenge for anesthesiologists, because the operation time is relatively long (Kumar & Dodds, 2006;Wulff, 2018). In the past, general anesthesia was the anesthetic of choice for vitreoretinal surgery.…”

“…The goal of ideal local anesthesia is to obtain complete anesthesia and akinesia of the eye ball and low intraocular pressure in order to provide optimal surgical conditions (Gioia et al, 2004;Miranda et al, 2021;Nicholson et al, 1999;Pacella et al, 2013;Ribeiro et al, 2020;Wulff, 2018). Peribulbar blockade is the preferred technique compared to retrobulbar blockade, because peribulbar blockade has fewer complications such as brainstem anesthesia, optic nerve injury (Di Donato et al, 2006;Varshney et al, 2017).…”