Articaine versus lidocaine with and without dexmedetomidine for peribulbar anesthesia in phacoemulsification

Abstract

Background The aim of this study was to compare the use of articaine versus lidocaine either with or without dexmedetomidine for peribulbar anesthesia in phacoemulsification. Patients and methods This is a prospective, randomized double-blind study that included 120 adult patients subjected to phacoemulsification with peribulbar anesthesia. They were randomly allocated into four groups: articaine (group 1, A), lidocaine (group 2, L), articaine–dexmedetomidine (group 3, AD), and lidocaine–dexmedetomidine (group 4, LD). Ocular akinesia was evaluated using Brahma scoring system. Pain assessment was carried out by four-point verbal rating score. Patient satisfaction and surgeon satisfaction were also recorded. Results Regarding the ocular movement score, a statistically significant lower score was recorded in group 3 (AD) when compared with each of the other groups. Within each group, there was a significant decrease in eyelid score at 5, 10 min and end of surgery when compared with baseline score. Regarding the mean duration of globe akinesia, it was significantly longer in group 3 (AD) (139±20.4 min) in comparison with the other groups [group 4 (LD)=120.83±21.09 min, group 1 (A)=73±10.55 min, and group 2 (L)=50.33±4.9 min]. Patient satisfaction was significantly better in group 3 (AD) and in group 4 (LD). Surgeon’s satisfaction was significantly better in group 1 (A), group 3 (AD) and group 4 (LD) when compared with group 2 (L) and in group 1 (A) and group 3 (AD) in comparison with group 4 (LD), with the best quality detected in group 3 (AD). Conclusion Articaine was superior over lidocaine for peribulbar block in achieving shorter onset and longer duration of globe akinesia and anesthesia. Addition of dexmedetomidine improved the quality of each.