Choice of local anesthetic for peribulbar block: literature review

Abstract

Procedimentos cirúrgicos oftalmológicos são realizados, em sua maioria, em pacientes com idade avançada e que apresentam diversas comorbidades clínicas, trazendo subsequentes preocupações com o emprego de anestesia geral. Há, portanto, preferência pela anestesia regional, sendo o bloqueio peribulbar o mais executado na prática. Não há consenso ou recomendação sobre qual anestésico local apresenta melhor perfil de qualidade e segurança para realização de bloqueios oftalmológicos. Há muitos estudos comparando diversas drogas na literatura, porém não há revisão sobre o assunto agrupando os diferentes resultados. O objetivo deste artigo é fazer uma revisão comparando os anestésicos locais usados na rotina quanto à eficácia, pressão intraocular, possibilidade de intoxicação sistêmica e satisfação do paciente e do cirurgião.

Efficacy of ropivacaine versus bupivacaine in preventing peribulbar block failure: A meta-analysis

“…The mixture of lidocaine with another anesthetic has as its objective a rapid onset of action associated with longer duration. 41 Therefore, as shown in this study, in peribulbar blocks in the absence of ropivacaine, the use of lidocaineassociated bupivacaine results in equivalent effects in relation to failure of the blockade. Levobupivacaine is another drug commonly used in anesthesia for ophthalmic surgery.…”

Addition of Hyaluronidase Reduces Failure of Regional Block in Ophthalmic Surgery: Meta-Analysis of Randomized Clinical Trials

“…On the other hand, a disadvantage of bupivacaine relies in its more evident cardiotoxicity than lidocaine [27]. Lidocaine has a pKa closer to the physiological one, which implies shorter latency, faster onset of action, but also shorter duration, with the need to repeat supplementary doses, including intraoperatively [6,28]. This, in theory, can justify the non-association shown in this meta-analysis.…”

“…The use of hyaluronidase, evaluated in the 15 studies sources [7,14,[15][16][17][18][19][20][21][22][23][24] regardless of the type and concentration of LA, hyaluronidase dose and regional blocking technique, was considered a protective factor against ocular akinesia failure in ophthalmic surgery (OR: 0.55; 95% CI: 0.32-0.93; p=0.027), as shown in Figure 2. (5 studies [14,19,20,22,23]; OR: 0.34; 95% CI: 0.09-1.34; p=0.12) or in PB (10 studies [7,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]21,24]; OR: 0.65; 95% CI: 0.40-1.07; p=0.09). Still on the hyaluronidase dose, regardless of the type and concentration of LA and the regional blocking technique, the use of a dose greater than 100 IU / mL was considered a protective factor, as it prevented akinesia failure in ophthalmic anesthesia (7 studies [7,14,16,18,19,21,22]; OR: 0.43; 95% CI: 0.20-0.90; p=0.02) (Figure 3).…”