Intraocular Pressure, Quality of Block, and Degree of Pain Associated with Ropivacaine in Peribulbar Block: A Comparative Randomized Study with Bupivacaine-Lidocaine Mixture

Abstract

Ropivacaine used in peribulbar block is better than bupivacaine-lidocaine mixture under the same standard conditions in terms of reducing intraocular pressure and postoperative pain in intraocular surgery.

Intraocular Pressure and Quality of Blockade in Peribulbar Anesthesia Using Ropivacaine or Lidocaine with Adrenaline: A Double-Blind Randomized Study

“…There were no significant differences in the IOP levels between the groups, even though the IOP was decreased significantly below baseline values at 10 min in the ropivacaine group. It has been reported that the vasoconstrictive effect of ropivacaine leads to a decrease in the intraocular blood volume and that this might play a role in the observed decrease in the IOP (Nakamura et al 1993;Ishiyama et al 1997;Nociti et al 2001;Ozcan et al 2003). In addition, the IOP might have been decreased in the ropivacaine group because the diffusion of ropivacaine through the tissues may be faster than that of lidocaine.…”

“…Evidence suggests that ropivacaine has a higher threshold for cardiovascular and central nervous system toxicity than does bupivacaine and a lower threshold than does lidocaine (Arlock 1988;Feldman et al 1989). In addition, the quality of the motor block, the duration of analgesia, and the pain of injection induced by ropivacaine used in peribulbar anesthesia were superior to those observed with other anesthetics (Luchetti et al 2000;Ozcan et al 2003). It has been shown that adrenaline does not increase the efficacy of ropivacaine owing to the inherent vasoconstrictive properties of ropivacaine (Cederholm et al 1992).…”

“…Prolonged motor block and prolonged analgesia may be preferable in cataract surgery. Ozcan et al (2003) reported that 0.75% ropivacaine resulted in lower post-operative pain scores than did a bupivacainelidocaine mixture.…”

“…The use of mixtures of local anesthetics for regional anesthesia has recently become popular, based on the premise that rapid-acting agents with short duration of effect could compensate for the longer latencies associated with agents that have longer duration of effect. However, some studies have shown that there were no clinically significant advantages to the use of mixtures of local anesthetic agents (Berde and Strichartz 2000;Luchetti et al 2000;Nicholson et al 2000;Perello et al 2000;Ozcan et al 2003). In addition, using a single effective agent is preferable to an unnecessary polypharmacy approach.…”

“…Ropivacaine is a long-acting local anesthetic used as a single agent in peribulbar anesthesia for cataract surgery (Nociti et al 1999;Nicholson et al 1999Nicholson et al , 2000Luchetti et al 2000;Perello et al 2000;Ozcan et al 2003). Evidence suggests that ropivacaine has a higher threshold for cardiovascular and central nervous system toxicity than does bupivacaine and a lower threshold than does lidocaine (Arlock 1988;Feldman et al 1989).…”