Bupivacaine and lignocaine for ophthalmic surgery.

Abstract

SUMMARY Bupivacaine 0°5% when used as a local anaesthetic for ocular cataract surgery does not give absolute ocular akinesia but provides adequate and prolonged pain relief. In comparison lignocaine provides good ocular akinesia at operation but pain relief is short lived. In the present study the adequacy of analgesia, operating conditions, and complications were compared for three drug regimens under standard operating conditions. The retrobulbar block was performed with either lignocaine or bupivacaine or a mixture of lignocaine and bupivacaine according to a predetermined protocol.The success of any nerve block depends on the operator, who requires a thorough knowledge of the anatomy. Diffusion of drugs is restricted by anatomical boundaries, and correct placement of drugs leads to a smaller dose being necessary. The study was therefore designed for blocks to be performed solely by the operator, so as to use the minimal doses of the various local anaesthetics to give acceptable ocular anaesthesia and akinesia. Material and methodsNinety adult consenting patients were allocated randomly to one of three groups (A, B, and C), 30 patients in each group. Group A had their cataract surgery performed under bupivacaine as the local Correspondence to Rcvd Professor E 0 Oji, FRCS, University of Jos Medical School, Jos, Plateau State, Nigeria.anaesthetic. Group B had their cataract surgery under lignocaine, and in group C a mixture of lignocaine and bupivacaine was administered.Each patient received 75 mg of pethidine intramuscularly one hour preoperatively to provide minimal sedation and analgesia. Thirty minutes before surgery each patient also received topical drops of 0*4% oxybuprocaine to the eye for surgery every 5 to 10 minutes till the operation began.Group A patients received 1-5 ml of 0-5% bupivacaine through a retrobulbar needle, 4-0 ml of 0-5% bupivacaine at the stylomastoid foramen and around the parotid distribution of the facial nerve for the seventh cranial nerve block, band 0-5 ml of 0-5% bupivacaine each to the upper and lower lids for paralysis immediately before surgery.Similarly, group B patients received 1-5 ml of 2% lignocaine retrobulbarly, 4-0 ml of 2% lignocaine for the facial nerve block and 0-5 ml of 2% lignocaine each to the upper and lower lids.For the group C patients a mixture of 0-5% bupivacaine 3-5 ml and 2% lignocaine 3 5 ml was used. The two were thoroughly mixed before the C~H3 -m >~~~NH C t CH3N bupivacaine C H9 ACH3~1

Retrobular anaesthesia A clinical evaluation of four different anaesthetic mixtures

“…Chin & Almquist (1983) have shown that a lag of onset occurs when adrenaline is added to the mixture, and that this lag of onset is offset by the addition of hyaluronidase. In this case the drug of choice should be lidocain in combination with bupivacaine as proposed by Oji (1987). We have used adrenaline for many years in order to reduce the risk of toxic adverse reactions and retrobulbar haemorrhage, and we feel that adrenaline is an indispensable drug in that respect.…”

A Comparative Study Between Bupivacaine with Adrenaline and Carbonated Bupivacaine with Adrenaline for Surgical Removal of Impacted Mandibular Third Molar

“…Many studies reported that the combination of lidocaine hydrochloride with long acting local anesthetic will increase the duration of action and decrease patient discomfort [18]. Bupivacaine hydrochloride along with lidocaine hydrochloride is widely used for ophthalmic surgery as it has long duration of action [19] and there was no significant difference in cardiovascular response between the two groups [20]. Only few studies were conducted to compare the efficacy of carbonated bupivacaine with adrenaline with that of bupivacaine hydrochloride with adrenaline for surgical removal of impacted tooth.…”

Kinetic anaesthesia for laser surgery

“…[1][2][3][4][5][6][7] The standard LA block giving good analgesia combined with total akinesia has been superceded in many centres by topical anaesthesia, as a cooperative patient can provide acceptable surgical conditions with rapid patient recovery.…”

“…Over the last 10 years anaesthesia for cataract surgery has moved from general, to peribulbar to topical anaesthesia. [1][2][3][4][5][6][7] Vitreoretinal (VR) surgery has followed a similar pattern in many centres. Local anaesthesia has replaced general anaesthesia as it is well tolerated by patients and allows rapid postoperative recovery.…”