Use of Piritramide for Analgesia and Sedation during Peribulbar Nerve Block for Cataract Surgery

Abstract

Purpose: To investigate the effects of pre-block analgesia and sedation using piritramide on haemodynamic stability, endocrine stress response and patients’ pain perception. Methods: In a randomized, single-blinded, placebo-controlled study, 60 patients having cataract surgery with peribulbar block were randomly assigned into two groups: group A (n = 30) received 0.05 mg/kg piritramide (Dipidolor^®) intravenously; group B received normal saline intravenously prior to peribulbar block. Mean arterial pressure, heart rate, respiratory rate and pulse oximetry were recorded perioperatively. Pain from peribulbar block was assessed using a verbal analogue scale. Urinary excretion of vanillylmandelic acid was measured to assess the endocrine stress response. Using a questionnaire, patients assessed their anxiety and back pain before and during surgery. Results: Mean arterial pressure remained near baseline in group A. In group B, a significant increase in mean arterial pressure after peribulbar block was found (p < 0.001). In addition, a significant increase in urinary excretion of vanillylmandelic acid was found in group B (p = 0.013). Pain scores (p < 0.001), anxiety before nerve block (p = 0.02) and during surgery (p < 0.001) and back pain (p = 0.003) were significantly lower in group A. Conclusion: The presented study suggests that using piritramide for analgesia and sedation prior to peribulbar block produces haemodynamic stability and reduces pain perception and endocrine stress response.