Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

Abstract

Purpose To assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification. Methods One hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0-10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded. Results There was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (Po0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (Po0.01).Conclusions Topical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

Induction of apoptosis of rabbit corneal endothelial cells by preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, or levobupivacaine 0.75%

“…[1][2][3][4][5][6] Lidocaine, ropivacaine, and levobupivacaine are 3 commonly used topical anesthetic agents in modern cataract surgery. [7][8][9] Topical anesthesia does not provide adequate motor and sensory anesthesia and may be associated with increased intraoperative pain and complications. 4 Therefore, intracameral injection of unpreserved lidocaine 1% has become a commonly used adjunctive anesthetic agent during cataract surgery.…”

Topical Anesthesia with Ropivacaine and Proparacaine for Intravitreal Injection Procedures

“…It provided sufficient and long-lasting analgesia without the need for supplemental intracameral anesthesia in most cases [10]. In a relative study, Borazan et al, concluded that topical anesthesia with ropivacaine was safe, feasible and more effective than lidocaine in cataract surgery [11].…”

“…Before commencing our study, the only published data on topical ocular surface anesthesia with ropivacaine were cataract and pterygium extraction operations [9][10][11]. We wished to determine whether ropivacaine as the sole anesthetic could provide satisfactory ocular surface anesthesia for intraocular injection procedure.…”

Cataract Surgery Complications

“…Recent in vitro and in vivo studies have confirmed the toxic effect of lidocaine on ganglion cells. [10,11] Furthermore, the short duration of the local anesthetic makes administration of a second dose during cataract surgery necessary, thus increasing the risk of toxicity. Ropivacaine, which has recently been introduced in clinical surgery, can represent a valid alternative to lidocaine in intracameral anesthesia.…”