Lid Akinesia Research Articles

Evaluation of lidocaine for auriculopalpebral nerve block in dogs: Onset, duration, and effects on intraocular pressure and eye examination.

Accurate intraocular pressure (IOP) measurement is essential for managing glaucoma, requiring tonometry. Local anesthesia is typically used, but nerve blocks may be needed for blepharospasm. This study investigated the efficacy of auriculopalpebral nerve block with lidocaine in achieving eyelid akinesia and its influence on IOP in dogs. In a randomized, blinded trial, 12 healthy adult mixed-breed dogs (24 eyes) received either auriculopalpebral nerve block with 2% lidocaine (n = 12 eyes) or no block (n = 12 eyes). Tetracaine drops were used for topical anesthesia in half of blocked/non-blocked eyes, and the rest of the eyes got artificial tears as control. The impact of nerve block was evaluated through assessments of menace response, palpebral reflex, and IOP before the block, after drop instillation, and at 15-min intervals until block dissipation. Auriculopalpebral nerve block provided effective eyelid akinesia in 58.5% (7/12 eyes) at 15 min, reaching 91.7% (11/12 eyes) at 30 min, indicating peak efficacy. Subsequently, the block gradually diminished, with 66.7% (8/12 eyes) and 33.3% (4/12 eyes) maintaining akinesia at 45 and 60 min, respectively. Importantly, neither auriculopalpebral nerve block nor tetracaine administration significantly affected IOP measurements (p > .05). Auriculopalpebral nerve block using lidocaine demonstrated efficient eyelid akinesia, peaking at 30 min postinjection. This technique proved to be safe with no notable alterations in IOP, suggesting its potential utility in canine ophthalmology for procedures requiring eyelid akinesia, particularly in the management of glaucoma where maintaining accurate IOP measurements is crucial for diagnosis, treatment, and monitoring the disease.

Comparative Study between Rocuronium And Magnesium Sulfate as Adjutants to Regional Anesthesia for Ophthalmic Surgeries using Peribulbar Block

Abstract Background Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, it has the disadvantages of a slower onset of orbital akinesia and the frequent requirement for block supplementation. Aim of the Work To evaluate the effect of addition of magnesium sulfate and rocuronium to standard local anesthetics mixture on the time of onset of globe and lid akinesia and corneal anesthesia for peribulbar block in ophthalmic surgeries. Patients and Methods This Prospective Double-blinded Randomized Study was carried out in the ophthalmic surgery unit, Ain Shams university hospital from January 2019 to April 2020. After institutional Ethical Board approval and obtaining written informed patients’ consents, 75 patients from both sexes, ASA physical status I-III, aged 40-80 years and having an Axial globe length less than or equals 26 mm scheduled for cataract surgery under peribulbar block were included in the study. Results Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00±1.22) than control group and magnesium sulfate group (9.00±1.47 and 9.00±1.15) respectively, (p < 0.001); Moreover, no statistically significant difference was reported between control group and magnesium sulfate group. In addition, no significant difference was reported regarding duration of surgery between groups Conclusion Adding Rocuronium to local anesthetic mixture in peribulbar block during cataract surgery enhances ocular akinesia and corneal anesthesia and reduces the need for supplementary injections with no side effects and that was significantly better than Magnesium sulfate in term of rapid onset and time needed to achieve adequate condition to begin surgery. However, adding Magnesium sulfate showing good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery.

Effects of addition of fentanyl to lidocaine plus adrenaline during peribulbar anaesthesia for cataract surgery: A prospective study

Background: Local anaesthesia is most commonly used for cataract surgery in adult patients. Different combinations of local anesthetic agents and adjuvants have been used to provide adequate anaesthesia and analgesia. This study assessed the effect of adding 25 µg fentanyl to lidocaine with adrenaline mixture on the onset and duration of anaesthesia in adult patients undergoing cataract surgery under peribulbar anaesthesia. Methods: This was a double blind, randomized controlled study. Adult patients aged 40 years and above with American Society of Anesthesiologists Physical Status Classes 1 and 2 undergoing cataract surgery under peribulbar block (PB) were studied. Sixty-six patients were randomized into two equal groups. Group A had 25 µg fentanyl (0.5 mL) added to 6 mL of 2% lidocaine with adrenaline while Group B had sterile water 0.5 mL added to 6 mL of 2% lidocaine with adrenaline for PB. Onset and duration of lid akinesia, globe akinesia, globe anaesthesia, Numerical Rating Scale (NRS) pain score, time to analgesia request as well as patient and surgeon satisfaction were assessed. Results: The differences in the onset of lid akinesia, globe akinesia, and globe anaesthesia between the two groups were statistically significant (P ≤ 0.001, respectively). The mean duration of globe akinesia and globe anaesthesia was longer in Group A as compared to Group B (P = 0.008 and P = 0.009, respectively). Statistically significant differences in median NRS scores were found at the 4th, 5th, and 6th h (P = 0.001, respectively). The mean duration to analgesia request was 238.1 ± 65.5 min in Group A compared to 207.2 ± 49.1 min in Group B (P = 0.034). Conclusion: The addition of 25 µg fentanyl to 2% lidocaine plus adrenaline mixture improved the quality of peribulbar anaesthesia and is recommended in Nigerian adults scheduled for cataract surgery under peribulbar anaesthesia to improve their surgical experience.

Comparative efficacy of mepivacaine vs. bupivacaine added to lignocaine plus hyaluronidase for percutaneous peribulbar injection in cataract surgery

Background: Peribulbar anesthesia had been developed as a safer, easier, and effective alternative to retrobulbar anesthesia that provides ocular akinesia and anesthesia.
 Objective: This study aimed to compare the efficacy of mepivacaine 3% – lidocaine 2% hyaluronidase mixture with that of bupivacaine 0.5% – lidocaine 2% - hyaluronidase to produce optimal operative and post-operative conditions in patients receiving single peribulbar injection for cataract surgery.
 Patients and Methods: In this randomized, double -blind study, 90 adult patients were assigned to one of two groups (M and B), each comprising 45 patients. Study participants received 6-8 ml combination of equal parts of either mepivacaine 3% (Group M) or bupivacaine 0.5% (Group B) both with lidocaine 2% and hyaluronidase 25 IU/ml. Akinesia was assessed with a 12-point scale at 2, 5, 10 and 15 min after injection. Onset of sensory block, time to start surgery, pain and requirement for supplemental injection were also assessed.
 Results: Group M showed better akinesia scores than Group B and the onset of globe akinesia and sensory block were significantly faster in Group M. The duration of globe and lid akinesia was longer in Group B (159.16 ± 5.71 min and 150.02 ± 4.42 min, respectively) than in Group M (142.89 ± 6.52 min and 135.69 ± 4.81 min, respectively) and this showed statistical significance (P < 0.001). The percentage of patients who required supplementary injection was significantly higher in Group B (7 patients) compared to that in Group M (2 patients).
 Conclusion: Using a mixture of mepivacaine and lidocaine gives perfect globe akinesia and quicker establishment of appropriate conditions to start cataract surgery and shortens the block onset time with faster recovery compared with the addition of bupivacaine to lidocaine in peribulbar anesthesia.
 Trial registration: Registered at http:// www.pactr.org; No. PACTR201810828658359. Dated: October8, 2018.
 Abbreviations: ASA PS - American Society of Anesthesiologists Physical Status; PACU - Post Anesthesia Care Unit; VRS - Verbal Rating Scale; PBA - Peribulbar Anesthesia
 Key words: Peribulbar block, Cataract extraction, Mepivacaine, Lidocaine, Bupivacaine.
 Citation: Saleh AN, Haiba Ali Ibrahim DM, Zekry MR. Comparative efficacy of mepivacaine vs. bupivacaine added to lignocaine plus hyaluronidase for percutaneous peribulbar injection in cataract surgery. Anaesth. pain intensive care 2023;27(5):464−470; DOI: 10.35975/apic.v27i5.2167
 Received: April 09, 2023; Reviewed: August 08, 2023; Accepted: August 18, 2023

Ketamina frente a midazolam como adyuvante para el bloqueo peribulbar utilizando una única inyección inferonasal en los pacientes sometidos a vitrectomía: ensayo controlado aleatorizado

Introduction and objectivesThis study aimed to assess the safety and efficacy of midazolam and ketamine as adjuvants to the peribulbar block in vitreoretinal surgeries. Patients and methodsThis randomized controlled trial included 93 adult patients undergoing vitreoretinal surgeries performed with peribulbar anaesthesia. Patients were randomly allocated to 3 groups (31 participants each): control (standard anaesthetic mixture), midazolam (standard mixture+midazolam), and ketamine (standard mixture+ketamine). The primary outcomes were onset of globe akinesia and duration of analgesia. Secondary outcomes were duration of motor blockade, onset of corneal anaesthesia and lid akinesia, and changes in vital data (blood pressure, oxygen saturation, and pulse rate). ResultsThe ketamine group vs. the control and midazolam groups showed the most rapid onset of lid and globe akinesia (p<0.001) and corneal anaesthesia (0.7±0.2 vs. 1.5±0.5 and 1.2±0.4, respectively; p<0.001) and the longest duration of both analgesia (3.7±0.6 vs. 2.3±0.4 and 3.1±0.6, respectively; p<0.001) and akinesia (3.8±0.5 vs. 3.0±0.4, and 3.7±0.5, respectively; p<0.001). The midazolam group showed better outcomes than controls, but the drug was less effective than ketamine. There were no significant differences in vital data among groups (p>0.05). ConclusionsKetamine is an effective adjuvant for peribulbar blockade. It enhances both motor and sensory blockade by hastening onset and prolonging duration. These effects are desirable in lengthier ophthalmic procedures such as vitreoretinal surgeries. The effects of ketamine were superior to those of midazolam.

Fentanyl as an adjuvant to the local anesthetic in the peribulbar block for vitrectomy operations

ABSTRACT Background Adding certain drugs to the local anesthetics (LA) in peribulbar block (PBB) increases its intensity and duration of action, so we did this research to assess the impact of fentanyl addition to the LA in PBB for vitrectomy. Methods Forty patients were divided into: Control group: They got 9.5 ml of 0.5% bupivacaine (6 ml), 2% lidocaine (1.5 ml), 45 IU hyaluronidase (in 1.5 ml lidocaine), and 0.5 ml saline. Fentanyl group: They got the same medications plus 0.5 ml (25 mcg) of fentanyl instead of the saline. Our primary outcome was the duration of the block, and our secondary outcomes were the start of the motor block, scores for globe and lid akinesia, the quality of the block, scores for patient and surgeon satisfaction, postoperative VAPS, and the first request for analgesia and complications from the drugs used or the technique. Results The start of the motor block was significantly rapid in the fentanyl group. Additionally, there were notable variations in the length and intensity of the block between the two groups. The postoperative pain score was lower in the fentanyl group. While it was acceptable in the control group, the block quality was perfect in the fentanyl group. Complete patient satisfaction happens more often in the fentanyl group. There were no complications reported. Conclusion Fentanyl, when added to LA mixtures in PBB in vitrectomy, decreased the onset, increased the duration of lid and globe akinesia, and improved the quality of analgesia without causing any complications.

The effect of adding magnesium sulphate as an adjuvant to peribulbar block for glaucoma surgery in morbidly obese patients: A randomized controlled study

ABSTRACT Background This study aimed to evaluate safety and efficacy of magnesium sulphate as an adjuvant to peribulbar block at two different doses (75 and 100 mg) in reducing intraocular pressure (IOP) in obese patients undergoing glaucoma surgery. Methods Forty-six adult patients, American Society of Anesthesiologists status I–III, with body mass index of 30–55 kg/m2 undergoing glaucoma surgery under peribulbar block were enrolled during February, 2021. Patients were randomly assigned into two groups (1:1). Both groups received 4 ml of lidocaine 2%, 4 ml of bupivacaine 0.5%, and 1 ml of hyaluronidase (10IU of hyaluronidase/ml of lidocaine). Magnesium sulphate was added to this mixture either in a dose of 75 mg (group I) or 100 mg (group II). Primary outcomes included onset of globe and lid akinesia and IOP. Secondary outcomes included durations of analgesia and motor block, patients’ and surgeons’ satisfaction, and vital data. Results The mean onsets to globe and lid akinesia were significantly lower in group II compared to group I (2.7 vs. 4.2 min, p < 0.001 and 3.1 vs. 4.2 min, p = 0.001, respectively). After the block, the mean IOP was significantly lower in group II at 1 min (27.2 vs. 32.7 mmHg, p = 0.0034), 3 min (26.5 vs. 32.4 mmHg, p = 0.002) and 5 min (26.2 vs. 32.1 mmHg, p = 0.001). Group II had a significantly longer mean durations of analgesia (3.5 vs. 2 hours, p < 0.001) and recovery of motor block than group I (3.3 vs. 2.3 hours, p < 0.001). No complications were encountered during the surgery. Conclusion Magnesium sulphate at a dose of 100 mg demonstrated higher efficacy while maintaining safety compared to the dose of 75 mg.

Comparison of Efficacy and Safety of Subtenon’s Anaesthesia with and without Hyaluronidase in Bilateral Cataract Patients

Background: The effect of subtenon’s block with the usage of hyaluronidase in terms of analgesia and akinesia was studied in different sets of people and the results were not satisfactory in all of them .This study eliminates bias and mitigates the confounding factors such as age, sex, pain threshold of a person, anatomical variations when done on different individuals. Objectives: To evaluate the efficacy of subtenon’s anaesthesia with hyaluronidase in group A patients and without use of hyaluronidase in group B undergoing cataract surgery in terms of Globe and lid akinesia, analgesia, onset and duration of anaesthesia intra operatively and to document complications related to subtenon’s anaesthesia. Methods : 39 patients (78 eyes) who fulfil inclusion criteria were selected and subtenon’s anaesthesia with hyaluronidase during the first eye cataract surgery followed by other eye subtenon’s anaesthesia without hyaluronidase was adopted. the study is done at RLJH, Kolar in ophthalmology department which is a teritiary setting hospital. In both groups Analgesia was graded between 0-4 grades and globe akinesia was graded between 0-3 grades and lid movements was graded between 0-2 grades. Study design used is non randomized study. Results: Analgesia (p = 0.008), globe akinesia (p = 0.002)at 15 mins ,lid akinesia (p=0.027) at 10 mins were good in Group A and it was statistically significant. The rate of onset of akinesia, patient and surgeon satisfaction were better in case of Group A . Complications were equal in both the groups showing no role of hyaluronidase in the complications and relating them to subtenon’s. Conclusions: Hyaluronidase has shown better onset of akinesia, good intraoperative analgesia , good globe and lid akinesia. Keywords: Subtenon’s block , Hyaluronidase, Akinesia, Analgesia.

EFFICACY OF ADDITION OF MAGNESIUM AS AN ADJUVANT TO LOCAL ANAESTHETICS IN PERIBULBAR BLOCK: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND STUDY

Introduction: Topical, regional or general anesthesia can be used for ocular surgery. Among regional blocks, Peribulbar block is a good choice as it provides efficient anesthesia with good lid and globe akinesia with low incidence of complications.1 However the time for onset of akinesia with Peribulbar block is much longer in comparison to retro bulbar block,2which may lead to a delay to start the surgery. The incidence of inadequate analgesia is also more frequent with Peribulbar block2 in comparison to retro bulbar block, which may lead to the requirement of supplementary injection before the start of surgery or intraoperatively. Aims And Objectives: To evaluate the effect of addition of magnesium sulphate to standard local anesthetics mixture for peribulbar blocks in ophthalmic surgeries. Material And Methods: 60 patients who underwent ocular surgery under local anesthesia admitted at Malla Reddy Narayana Multispecialty Hospital, Hyderabad from May2018- october2018(6 months) were enrolled in the study.It was Prospective Randomized controlled double blind study.Inclusion criteria was patients between 20-70 years of either sex with ASA group 1-3 with both anterior and posterior chamber surgery under peribulbar block.Exclusion criteria were patient with mental retardation, allergic to local anesthetics, history of bleeding disorder, cardiac and respiratory diseases and ASA group4-5. Results: After studying 60 patients, out of which 30 patients included in control group (Group NS) and 30 patients in study (Group MS) group,a systematic statistical analysis done for Age and All patients were in age group of 20-70 years. Mean age was 59.0667 +- 7.08049 in the control group (Group NS) and 58.1667 +- 5.73605 in study group (Group MS). The p-value 0.591,which is statistically nonsignificant. Discussion:Anaesthesia plays a vital role in ophthalmic surgery.Most ophthalmic surgeries are carried out under local anaesthesia although topical anaesthesia is soon gaining popularity.The goal of anaesthesia in opthalmic surgery is to provide adequate analgesia and akinesia.Peribulbar block has been used widely for ophthalmic surgery as it is safer than a retrobulbar block. The time for onset of akinesia with peribulbar block is much longer in comparison to retrobulbar block2, which may lead to a delay to start the surgery.The incidence of inadequate analgesia is also more frequent with peribulbar block2 in comparison to retrobulbar block, which may lead to the requirement of supplementary injection before the start of surgery or intraoperatively. Conclusions: Faster onset of globe and lid akinesia after addition of Magnesium sulphate to the mixture of local anaesthetics in peribulbar block.The duration of globe and lid akinesia is prolonged but difference is not statistically significant in Group MS as compared to Group NS.

Effects of auriculopalpebral nerve block on ocular parameters in dogs

The objective of this study was to compare the effects of two local anesthetics used on auriculopalpebral block on eyelid akinesia, tear production, intraocular pressure (IOP) and tear break-up time (TBUT) in conscious dogs. A blind, randomized, prospective study was conducted to determine the effects of auriculopalpebral block using ropivacaine 0.75% and bupivacaine 0.5% in 12 healthy non-brachycephalic dogs (24 eyes). Threat response and eyelid reflex tests, Schirmer tear test (STT), IOP and tear break-up time were conducted before blockage and at 30, 60, 120, 240 and 360 minutes after application. A difference was observed between the values found at 30, 60, 120 and 240 minutes compared to baseline for threat response and eyelid reflex tests in the two groups evaluated, proving eyelid akinesia after blockages. No difference was found for STT, IOP and TBUT between baseline values and post-anesthesia times or between groups. It was possible to conclude that ropivacaine and bupivacaine on auriculopalpebral block in conscious dogs promoted eyelid akinesia for at least 240 minutes, not altering ocular physiological parameters of tear production, intraocular pressure, and tear break-up time after blockages.

Dexmedetomidine versus magnesium sulphate as an adjuvant to local anesthesia in single-injection percutaneous peribulbar anesthesia for cataract extraction

BackgroundThe aim of the study was to evaluate the impact of addition of dexmedetomidine or magnesium sulphate to the standard local anesthetics mixture as a primary objective and to compare between both as a secondary objective utilizing the single-injection percutaneous technique for peribulbar block. In this prospective randomized double-blinded clinical trial (RCT), sixty patients, both sexes, aged 45 to 75, with an ASA of I to III, were scheduled for cataract extraction operation. They were divided into three equal groups; each received a single injection peribulbar block of a mixture of 0.5% bupivacaine (3 ml) + 2 percent lidocaine (3 ml) + 120 IU hyaluronidase + (control group (C): 0.5 ml of normal saline; group D: 50 μg of dexmedetomidine; group M: 50 mg of magnesium sulphate in 0.5 ml) with a total injected volume of 7 ml each. The duration of sensory, motor block, need for supplementary doses, hemodynamics, and satisfaction of patients and surgeons were assessed.ResultsFor the primary outcome, both the dexmedetomidine and magnesium groups revealed statistically significant differences from the control group with shorter onsets of sensory block and lid akinesia (p value< 0.001 for both), shorter onset of globe akinesia for dexmedetomidine (p value<0.001) and for magnesium sulphate (p value=0.022), prolonged duration of lid and globe akinesia and sensory block (p value<0.001), better patient satisfaction (p value=0.044) but insignificant difference regarding surgeons’ satisfaction (p value= 0.117) and a less frequent, but statistically insignificant need for supplementary injection (p value=0.075). The demographic and clinical hemodynamics and oxygen saturation parameters were comparable between the three groups. For the secondary outcome, dexmedetomidine was superior to magnesium sulphate regarding onset of globe and lid akinesia (p value= 0.047 and 0.003, respectively), and durations of globe akinesia and sensory block (p value= 0.02 and 0.016, respectively). No complications related to the drugs or procedure were recorded.ConclusionsWhen compared to 50 mg magnesium sulphate, dexmedetomidine at a dose of 50 μg is a superior adjunct to local anesthetic combination in peribulbar block for cataract procedures in terms of start and duration of peribulbar block.

Ketamine versus magnesium sulphate as an adjuvant to local anesthetics in the peribulbar block for posterior segment surgeries: a randomized controlled study.

The use of an adjuvant to local anesthetics in the peribulbar block may improve block characteristics. The aim of this double-blinded, parallel-group, randomized, controlled trial was to evaluate the safety and efficacy of ketamine versus magnesium sulphate as adjuvants to the local anesthetic mixture of peribulbar block in patients scheduled for vitreoretinal surgeries. A total of 126 patients scheduled for vitreoretinal surgery were randomly allocated as either ketamine (GK, N.=42), magnesium sulphate (GM, N.=42), or control (GC, N.=42) groups. The primary outcomes were the onset and duration of globe akinesia, duration of lid akinesia, and onset of sensory block. Secondary outcomes included time to start surgery, duration of analgesia, intraocular pressure, and patient and surgeon satisfaction. The use of either ketamine or magnesium significantly shortened the onset of globe akinesia, enhanced the onset of sensory block, prolonged the duration of globe and lid akinesia, minimized the time required to start surgery, and increased the total analgesic time. The effect of magnesium was significantly more pronounced on durations of globe and lid akinesia as well as analgesia, whereas ketamine significantly shortened the time required to start surgery. Both patient and surgeon satisfaction were significantly improved with the use of either drug. In vitreoretinal surgeries the use of either ketamine or magnesium sulphate as adjuvants to the local anesthetic mixture of peribulbar block improved the onset, duration, and quality of the block, offered better patient and surgeon satisfaction, and was not associated with drug adverse effects or surgical complications.

EFFECT OF USING FENTANYL AS AN ADDITIVE WITH THE LOCAL ANAESTHESTIC MIXTURE IN PERIBULBAR BLOCK FOR CATARACT SURGERIESA PROSPECTIVE RANDOMIZED CONTROL STUDY

INTRODUCTION: Cataract surgery is one of the most commonly performed surgery in the elderly patients. Regional anesthesia is safe, reliable, provide adequate akinesia and analgesia of the eye, a good postoperative pain relief and a shorter hospital stay. The various regional anesthetic techniques used in ophthalmic surgeries are peribulbar block, retrobulbar block, sub tenon's block, subconjunctival block and topical corneo-conjunctival anesthesia. Due to its safer approach, the peribulbar block is most commonly. Addition of an opioid like fentanyl to the anesthetic preparation will provide a faster onset of lid and globe akinesia, faster onset of sensory blockade, increase the duration of analgesia and reduce the need for rescue analgesia postoperatively. AIM OF THE STUDY: To evaluate the effect of addition of fentanyl to the local anesthetic mixture in peribulbar block in cataract surgery. MATERIALS AND METHODS: This study was done in the Department of Anesthesiology in collaboration with the Department of Ophthalmology in Kanyakumari Government Medical College from January 2019 to December 2019. Patient posted for cataract surgery were allocated into two groups by randomization (30 each). Group S – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 0.5ml normal saline. Group F – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 25 mcg Fentanyl (0.5 ml). The Parameters related to the study such as Onset of lid akinesia, Onset of globe akinesia, Onset of sensory blockade, Duration of analgesia by VAS score, Level of sedation by Ramsay sedation score, vital parameters – SpO , pulse rate, respiratory rate, blood pressure and any 2 Complications were recorded. RESULTS: We found that the demographic parameters were comparable and statistically insignicant. The preoperative hemodynamic parameters like the systolic and diastolic blood pressure, pulse rate, SpO2, respiratory rate were statistically insignicant and comparable. The mean onset of lid akinesia was 5.8 ± 1.76 mins and 3.13 ± 1.25 mins in Group S and Group F respectively. The mean onset of globe akinesia was found to be 7.46 ± 2.22 mins and 4.2 ± 1.60 mins in Group S and Group F respectively. The mean onset of sensory blockade was 6.8 ± 1.24 mins and 4.93 ± 1.63 mins in Group S and Groups F respectively. Thus the onset of globe and lid akinesia and the onset of sensory blockade was faster in Group F compared to Group S. The mean VAS scores were statistically signicant (P&lt;0.001) between both the groups at 1 hour, 1.5 hour, 2 hour, 4 hour, 6 hour postoperatively and it was found that Group F has a lower VAS score when compared with Group S. The VAS score at 8 hour and 10 hours postoperatively were statistically insignicant (p&gt;0.05) in both the groups. The mean duration of analgesia was 4.56 ± 1.65 hours in Group S and 7.63 ± 2.55 hours in Group F and was found to be statistically signicant(P&lt;0.001). CONCLUSION: Based on this study, we can conclude that there is a faster onset in the lid akinesia, globe akinesia, in the onset of sensory blockade and a substantial increase in the duration of analgesia when fentanyl is used as an additive along with the local anesthetic mixture in peribulbar block for cataract surgery

Tramadol as an adjuvant to peribulbar anesthesia

Background A large number of additives have been used as an adjuvant to local anesthetic (LA) mixture in peribulbar block to fasten the onset, enhance the potency, and prolong the duration of the block to cover the long duration of vitreoretinal surgeries and provide better postoperative analgesia. The authors designed a prospective, randomized, double-blind, controlled clinical trial to assess the effect of adding tramadol 20 mg to standard LA mixture concerning the onset of lid and globe akinesia, time for satisfactory block, and duration of postoperative akinesia and analgesia. Patients and methods A double-blind randomized study was done on 80 American Society of Anesthesiologists I and II patients scheduled for elective vitreoretinal surgery. Patients were chosen randomly into two groups, with 40 patients in each group. Group I (control group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) with 1 ml normal saline to a total volume of 10 ml. Group II (tramadol group) received a mixture of bupivacaine 0.5% (4 ml)+lidocaine 2% (4 ml)+hyaluronidase 150 IU (1 ml) supplemented with 20 mg tramadol in 1 ml normal saline to a total volume of 10 ml. The onset and duration of lid and globe akinesia and optimum time to begin surgery were recorded, in addition to postoperative visual analog score, duration of analgesia, and time to first rescue analgesic request. Results The results show statistically significant differences between the two groups, as tramadol group had faster onset of akinesia, better akinesia score, and shorter time needed to start surgery. In addition, tramadol group also showed significantly prolonged postoperative analgesia and akinesia with lower median pain score and less postoperative analgesic requirements. Conclusion The present study concluded that tramadol is a safe adjuvant to LA in peribulbar block that fastens the onset and prolongs the duration of lid and globe akinesia and improves the quality of analgesia without any obvious adverse effects.

Effect of fentanyl addition to local anesthetic mixture in peribulbar block for cataract surgery

Background In peribulbar regional anesthetic blocks, injection of local anesthetic mixtures alone provide unsatisfactory surgical conditions as regards block intensity and duration especially for relatively lengthy operations. So, additives may improve the quality of the block and provide good postoperative analgesia. Aim To examine the effect of adding fentanyl to local anesthetics in peribulbar block on the onset and duration of lid and globe akinesia (primary outcome) and postoperative analgesia (secondary outcome). Patients and methods Patients were classified randomly allocated in a blind manner into two groups; each group contained 30 patients. The control group received a measure of 7 ml [3 ml lidocaine 2%+0.5 ml hyaluronidase (150 U)+2.5 ml bupivacaine 0.5%+1 ml saline] which was used locally and the fentanyl group received a measure of 7 ml [3 ml lidocine2%+0.5 ml hyaluronidase (150 U)+2.5 ml bupivacaine 0.5%+1 ml saline containing 20 μg fentanyl] which was used locally. Results Statistically significant decreased mean time of complete akinesia decreases the mean time to sensory block in the fentanyl group compared with the control group. Conclusion Fentanyl is an effective drug as an additive to local anesthetic mixture in peribulbar anesthesia, as it shortens the onset time of corneal anesthesia and globe akinesia, prolongs block duration, and good postoperative analgesia.

Rocuronium versus cisatracurium as adjuvants to local anesthetic in peribulbar-induced akinesia

Background and objectives Peribulbar anesthesia is widely used in cataract surgery, but the beginning of akinesia is much slower and slower compared with retrobulbar technique. The effect of using adjuvant to the peribulbar block for the development of improved conditions in the absence of any adverse effects and in fastening the onset of akinesia has been implicated. We investigate the effect of the use of rocuronium, cisatracurium, and hyaluronidase as adjuvants for the local anesthetic on peribulbar-induced akinesia in relation to the grade of akinesia. Patients and methods A total of 135 women were assigned for cataract surgery to three groups (45 patients in each group), who received local eye anesthesia of a mixture (8 ml) containing equal amounts of Marcaine 0.5% and lidocaine 2%, containing hyaluronidase 15 IU/ml plus 0.5 ml saline 0.9% (group C); a mixture (8 ml) containing equal parts of 0.5% Marcaine and 2% lidocaine plus 0.5 ml cisatracurium (1 mg) (group A); and a mixture (8 ml) containing equal parts of 0.5% Marcaine, 2% lidocaine plus 0.5 ml rocuronium (5 mg) (group R). Lid akinesia, globe akinesia, hemodynamics, and adverse effects were evaluated among groups. Results After 1 min of injection, the number of patients reaching total akinesia was 15 (33%) with rocuronium, nine (20%) with cisatracurium, and zero (0%) in the control group. After 3 min of injection, the total number of individuals achieving total immobility was 21 (46%) with rocuronium, 15 (33%) with cisatracurium, and six (13%) in the control group. After 5 min of injection, the number of patients reaching total akinesia was 33 (73%) with rocuronium, 27 (60%) with cisatracurium, and 21 (46%) with the control group. At the 10th minute after injection, the number of individuals reaching total akinesia was 39 (86%) with rocuronium, 33 (73%) with cisatracurium, and 30 (66%) with control. In groups of rocuronium and cisatracurium, the total akinesia is relatively more frequent than in the control group. The number of patients with complete akinesia was higher in the rocuronium group after 10 min than in the cisatracurium and control groups, but there was no statistically significant difference among the three groups regarding lid akinesia. We did not notice any adverse effects related to the peribulbar block or the drugs used during the study. Conclusion This study demonstrated that addition of low-dose cisatracurium and rocuronium to the anesthetic drug is recommended to improve the quality of akinesia especially when hyaluronidase is not added.

Assessment of the Use of Ultrasound in Local Anesthesia for Ophthalmic Surgery

Eye surgery is the most common surgery in the elderly. Many ophthalmic procedures, such as cataract extraction can be performed safely in an outpatient setting, using regional anesthesia and mild sedation. The number of outpatient ophthalmic procedures will increase as the population continues to age. Advantages of regional anesthesia over general anesthesia are numerous; it is generally safer with less incidence of complications and less bleeding. Aim: The purpose of this thesis is to evaluate the use of ultrasonography in the performance of local anesthesia for ophthalmic surgery. This assessment includes whether ultrasound will add to the safety of the technique and its success rate. Patients and methods: After approval of our institutional ethics committee and obtaining a written informed consent, 100 adult patients having routine cataract extraction were divided randomly into: Group A (peribulbar anesthesia) and Group B (retrobulbar anesthesia), with 50 patients in each group. Each group was subdivided into two subgroups: In one the anesthesia was administered blindly, in the second using B-scan ultasonography, with 25 patients in each one. Patients randomly allocated to one of these four subgroups until the required number is reached in each group. Results: Results of the current study demonstrated comparable degree of globe akinesia after 10 minutes (p = 0.342). The majority of cases showed no globe movement after 10 minutes. Similarly, lid akinesia showed no significant difference between 4 groups (p = 0.082). This was accompanied by partial satisfaction of the majority of surgeons with the procedure; comparable in the 4 subgroups (p = 0.270). Conclusion: Peribulbar and retrobulbar regional anesthesia of the orbit during cataract surgery are safe procedures if blindly applied. Ultrasonography-guided needle injection doesn’t add to the safety and/or efficacy of the procedure. Therefore, ultrasound guidance is not an advantage in orbital regional anesthesia; whether administered by the peribulbar or retrobulbar technique.

Assessment of the Use of Ultrasound in Local Anesthesia for Ophthalmic Surgery

Eye surgery is the most common surgery in the elderly. Many ophthalmic procedures, such as cataract extraction can be performed safely in an outpatient setting, using regional anesthesia and mild sedation. The number of outpatient ophthalmic procedures will increase as the population continues to age. Advantages of regional anesthesia over general anesthesia are numerous; it is generally safer with less incidence of complications and less bleeding. Aim: The purpose of this thesis is to evaluate the use of ultrasonography in the performance of local anesthesia for ophthalmic surgery. This assessment includes whether ultrasound will add to the safety of the technique and its success rate. Patients and methods: After approval of our institutional ethics committee and obtaining a written informed consent, 100 adult patients having routine cataract extraction were divided randomly into: Group A (peribulbar anesthesia) and Group B (retrobulbar anesthesia), with 50 patients in each group. Each group was subdivided into two subgroups: In one the anesthesia was administered blindly, in the second using B-scan ultasonography, with 25 patients in each one. Patients randomly allocated to one of these four subgroups until the required number is reached in each group. Results: Results of the current study demonstrated comparable degree of globe akinesia after 10 minutes (p = 0.342). The majority of cases showed no globe movement after 10 minutes. Similarly, lid akinesia showed no significant difference between 4 groups (p = 0.082). This was accompanied by partial satisfaction of the majority of surgeons with the procedure; comparable in the 4 subgroups (p = 0.270). Conclusion: Peribulbar and retrobulbar regional anesthesia of the orbit during cataract surgery are safe procedures if blindly applied. Ultrasonography-guided needle injection doesn’t add to the safety and/or efficacy of the procedure. Therefore, ultrasound guidance is not an advantage in orbital regional anesthesia; whether administered by the peribulbar or retrobulbar technique.

Dexmedetomidine was Better at Lowering Intraocular Pressure than Magnesium when Combined with Local Anesthetics in Peribulbar Blocks for Posterior Segment Eye Surgery

Background and Aim: Many medications are combined with local anesthetics for peribulbar blocks to improve the quality of the block, however, few studies have compared the effect of dexmedetomidine and magnesium on intraocular pressure when combined with local anesthetics which was the primary endpoint of this double blinded study. Materials and Methods: A randomized controlled clinical trial was conducted on 60 ASA Physical Status (ASA PS) I-II patients scheduled for elective posterior segment eye surgeries under peribulbar anesthesia. Patients were randomly allocated to one of three groups of 20 each according to the medications they received. Local anesthetic solution was prepared using 8 ml of bupivacaine 0.5% and lidocaine 2% in a 1: 1 ratio plus 1ml of hyaluronidase (150 units) making a total volume of 9 ml: Group D received: local anesthetic + 20 µg dexmedetomidine diluted with 1 mL of normal saline. Group M received: local anesthetic + magnesium sulphate 50 mg in 1 ml normal saline. Group C received local anesthetic + 1 ml normal saline. Intraocular pressure was measured with the Perkins applanation tonometer immediately before injection and at 1, 5, 10, 15 minutes (min) after injection and then at the end of the procedure, the onset and duration of lid and globe akinesia were assessed. Postoperative analgesia and the first dose of analgesic medication were also assessed. Results: Intraocular pressure measurements were statistically lower in group D than the other two groups at 10 and 15mins. The onset of globe and lid akinesia was the most rapid in Group D compared to the other two groups. The duration of globe and lid akinesia was the longest in group D. Time to first analgesic dose request was significantly longer in group D followed by group M then group C. Visual analogue score for pain was significantly less between group D and other two groups. There were no episodes of hypotension or bradycardia in the three groups. No side effects or complications as hemorrhage, globe perforation, brain stem anesthesia sedation were observed. Conclusion: In our study addition of dexmedetomidine to a peribulbar block was statistically better at reducing IOP, increasing the duration of optic anesthesia and delaying the need for postoperative analgesic dose request than magnesium.

Magnesium sulphate versus Dexmedetomidine as adjuvants for local anasthetics in peribulbar block for eye surgeries: Clinical comparative study

Background: Regional anesthesia is a preferred technique for ophthalmic surgery. It is safe, inexpensive and provides efficient ocular anesthesia for ophthalmic surgery. It is associated with less hemodynamic instability, less respiratory depression, better postoperative pain relief, and less nausea and vomiting compared to general anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block due to a lesser incidence of serious complications such as brain stem anesthesia, globe perforation, and retrobulbar hemorrhage. Objective: The aim of the study was to compare the safety and efficacy of the use of Magnesium sulfate versus that of Dexmedetomidine as an adjuvant to the local anesthetic in peribulbar anesthesiaas for inducing optimal operating conditions for eye surgery in terms of akinesia (as a primary end point), analgesia, incidence of complications, as well as patient and surgeon satisfaction (as secondary end points). Patients and Methods: The present study included 50 patients (females and males) aged 20-80 years. Materials: Anesthetic drugs, Needles size: 25 gauge, Intravenous cannula 22 G, Drugs for premedications: intravenous midazolam (5mg/ml, Mediathetic, Amoun, Egypt) (0.01mg/kg) and Fentanyl Citrate (50µg/ml, Fentanyl- Janssen, Belgium) (25 µg)was administrated 5minutes before the block, Monitors for vital signs registration were done for each of the following: Electrocardiograph (ECG), non-invasive blood pressure (NIBP), heart rate (HR) and oxygen saturation (SpO2), respiratory rate (RR), Anesthetic machine, resuscitation equipment and drugs. Results: The current study was carried on 75 patients divided into Three equal groups: first group (control group), second group (dexmedtomedine group) and third group (magnesium sulphate group). All patients were scheduled for surgery. Conclusion: Addition of 50 mg of magnesium 10% or 15 mic of dexmedetomidine to local anesthetic mixture for peribulbar anesthesia in the operations of phacoemulsification of cataract and intraocular lens implantation accelerated onset of globe anesthesia, akinesia of the globe and the lid, prolonged the duration of globe akinesia, lid akinesia, time to 1st analgesic request, and enhanced the satisfaction of the patients and quality of the operative conditions.