Efficacy and Safety of Magnesium versus Dexmedetomidine as Additives to Local Anesthetic Mixture Using Single Injection Percutaneous Peribulbar Anesthesia in Vitreoretinal Surgeries

Aktham Shoukry,Amr Sobhy Abd El Kawy

doi:10.2174/2589645801812010094

Abstract

Background: Peribulbar block for vitreoretinal surgery is rather associated with delayed onset of globe anesthesia, akinesia and short duration of analgesia. Objective: To compare the effect of addition of Magnesium sulphate vs dexmedetomidine to standard local anesthetics mixtures on the time of onset of Globe Anesthesia, Akinesia & analgesia duration. Patients and Methods: Ninety patients of both sexes, aged 25- 75 years, ASA I-III scheduled for vitreoretinal surgery. They were randomly allocated into 3 equal groups each received peribulbar block a mixture of Levo- bupivacaine 0.5% (3 ml) + lidocaine 2% (3 ml) +120 IU hyaluronidase + Control group (C): 0.5 ml of Normal saline. Group (M): 50 mg of Magnesium sulphate in 0.5 ml normal saline. Group (D): 50 μic of dexmedetomidine in 0.5 ml normal saline. The duration of sensory, motor block, Sedation level, Intra-ocular Pressure (IOP) and surgeon satisfaction were assessed. Results: The onset of globe anesthesia and akinesia was significantly shorter in M group in comparison with D and C Groups, with a significant increase in the duration of globe analgesia and akinesia in the D Group when compared to both M & C groups. Groups D and M showed a statistically significant decrease in the IOP at 5 min and 10 min when compared to the baseline measurement of the same groups & to C Group, no complications or adverse effects related to the drug or technique were recorded. Conclusion: Magnesium sulphate as a local anesthetic adjuvant in peribulbar block is safe and comparable to dexmedetomidine regarding the sensory and motor block duration with better cost-effectiveness and availability.

Highlights

Vitreoretinal surgeries are one of the commonest operation performed across the world, they are deemed to be long and uncomfortable for patients to tolerate
Magnesium sulfate has been utilized for a long time with local anesthetic solutions in various techniques of regional anesthesia to decrease the onset time of the blockade and to enhance the quality and duration of anesthesia; such impacts are basically based on physiological calcium opposition and noncompetitive antagonist of N-methyl-DAspartate (NMDA) receptors [7] dexmedetomidine is centrally acting highly specific α2-agonist commonly used as sedative, preemptive analgesic and proved to decrease the onset of anesthesia and increase the duration of analgesia and akinesia in neuroaxial and regional blocks [8]
In order to find best local anesthetic adjuvant with least complication and best cost-benefit with simple technique, we compared the effect of addition of Magnesium sulphate vs dexmedetomidine to standard local Anesthetics mixtures on the time of onset of Globe Anesthesia, Akinesia and their duration with pain relief to suit the relatively long vitreoretinal surgeries producing optimal operating conditions

Summary

Introduction

Vitreoretinal surgeries are one of the commonest operation performed across the world, they are deemed to be long and uncomfortable for patients to tolerate. Magnesium sulfate has been utilized for a long time with local anesthetic solutions in various techniques of regional anesthesia to decrease the onset time of the blockade and to enhance the quality and duration of anesthesia; such impacts are basically based on physiological calcium opposition and noncompetitive antagonist of N-methyl-DAspartate (NMDA) receptors [7] dexmedetomidine is centrally acting highly specific α2-agonist commonly used as sedative, preemptive analgesic and proved to decrease the onset of anesthesia and increase the duration of analgesia and akinesia in neuroaxial and regional blocks [8] Both of them were tested in different concentrations as adjuvant to peribulbar anesthesia and their benefits regarding the quality of the block were tested in several studies [9, 10]. Peribulbar block for vitreoretinal surgery is rather associated with delayed onset of globe anesthesia, akinesia and short duration of analgesia

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Results

Discussion

Conclusion