Peribulbar Anesthesia For Cataract Surgery Research Articles

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 study between 0.5% bupivacaine versus 0.5% ropivacaine in peribulbar anesthesia for cataract surgery

Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P>0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P>0.05). (P>0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.

Comparing Peribulbar and Topical Anesthesia in Cataract Surgery among Patients with Cardiovascular Disease.

To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.

Comparison of Levobupivacaine over Lignocaine for Peribulbar Anesthesia in Cataract Surgery – A Randomized Control Study in a Tertiary Care Hospital

Abstract Introduction: Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform. Objectives: This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery. Methods: A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration. Results: In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P &lt; 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference. Conclusion: Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication.

Retinal perforation and local anaesthetic toxicity after peribulbar anaesthesia for cataract surgery

Retinal perforation and local anaesthetic toxicity after peribulbar anaesthesia for cataract surgery

Low-Dose Propofol with Peribulbar Anaesthesia for Cataract Surgery

In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP.

Ultrasound-guided versus conventional peribulbar anaesthesia in cataract surgery: A randomised controlled study.

Blind ophthalmic anaesthetic techniques may have serious complications. To assess the safety of ultrasound as a guide in ophthalmic blocks. Fifty adult patients undergoing cataract surgery under peribulbar block anaesthesia were randomly assigned to ultrasound-guided and conventional block groups. In the ultrasound-guided block group, a large amount of the standard ultrasound gel was applied to the closed eyelids. The globes were scanned in both sagittal and transverse planes. The patients were asked to look straight ahead with closed eyes without clenching the eyelids. The depth and gain were adjusted before performing the block. The primary outcome was the rate of complications. Secondary outcomes included the volume of injected anaesthetics and surgeon and patients' satisfaction. The local anaesthetic volume used was not significantly different between the two groups (7.08 ± 1.66 and 6.72 ± 1.97ml). The block onset, time and quality were comparable in both groups. No complications were reported, and there were no significant differences regarding surgeons' or patients' satisfaction with either procedure. The ultrasound-guided local ophthalmic block is as safe as the conventional method. Although its use was not superior to the conventional procedure, direct visualisation with ultrasound may be important to avoid vulnerable structures such as staphylomas.

Comparative study to assess the effect of ropivacaine and a mixture of lidocaine and bupivacaine on intraocular pressure after peribulbar anesthesia for cataract surgery.

To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post-block intraocular pressure (IOP). A one-year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40-70 years of age) planned for small-incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single-site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time-points: before block (control), 1-, 5-, and 15-minute post-block with a tonometer. The 1-minute post-block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1-minute post-block IOP was significantly less in the ropivacaine group. The 5- and 15-min post-block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine-bupivacaine group and baseline (control) ropivacaine values. The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small-incision cataract surgery can be a suitable alternative to the lidocaine-bupivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine-bupivacaine combination.

A comparative study of sodium bicarbonate and hyaluronidase on pain perception, anesthesia, and akinesia during peribulbar anesthesia for cataract surgery

Background:An ideal anesthetic solution should provide good anesthesia and akinesia with minimal pain on injection.Aims:The aim of this study is to determine the effect on pain perception and efficacy of sodium bicarbonate over hyaluronidase in the local anesthetic mixture during peribulbar anesthesia.Settings and Design:A prospective, randomized, double-blind study.Materials and Methods:An independent observer labeled two injections as A (hyaluronidase 1500 IU in 30 mL of lignocaine) and B (7.5% sodium bicarbonate 1 mL in 30 mL of lignocaine). Group 1 was injected with injection A while Group 2 was injected with injection B. The visual analog scale (VAS) was used to determine the intensity of pain. Onset and degree of anesthesia and akinesia were recorded.Statistical Analysis:Computer software Microsoft Excel SPSS version 26 (Chicago Inc) for windows was used. The qualitative data and quantitative data were reported as proportions and mean ± (standard deviation), respectively. Chi-square test for proportions was used for the comparison of qualitative variables and unpaired Student's t-test was used to test the significance between quantitative variables. P < 0.05 was considered statistically significant. All P were two-tailed.Results:Out of 123 patients, 23 were excluded from the study. Hundred patients were divided into Group 1 and Group 2. The mean age in Group 1 was 64.92 ± 10.77 years while in Group 2 was 62.86 ± 11.17 years. The mean heart rate and mean systolic blood pressure in both groups were statistically insignificant. Group 2 experienced very less pain (mean pain score VAS = 5.12 ± 1.17) as compared to Group 1 (mean pain score was 7.16 ± 1.09) and the difference between both the groups was found to be statistically significant. There was a significant difference in the onset of anesthesia in both groups (P = 0.001). In the sodium bicarbonate group, the onset was faster. The onset of akinesia was better in Group 1 (4.76 ± 2.06 min). Grading of akinesia was better in Group 1.Conclusion:Sodium bicarbonate reduces pain on injection in peribulbar anesthesia and also results in a quicker onset of anesthesia.

To compare peribulbar and subtenon anaesthesia in patients undergoing cataract surgery

To compare peribulbar and subtenon anaesthesia in patients undergoing cataract surgery. In a hospital based randomised comparative interventional study, patients who underwent cataract surgery were randomised into two groups, one receiving peribulbar and the other subtenon anaesthesia. Pain during administration, pain during surgery, chemosis, subconjunctival haemorrhage globe akinesia were noted and compared in the two groups. Any other complications which occur also noted. The pain during administration was significantly lesser in subtenon injection as compared to peribulbar anaesthesia. Pain during surgery was comparable in the two groups. Incidence of subconjunctival haemorrhage and chemosis was more in subtenon injection as compared to peribulbar anaesthesia. Globe akinesia was achieved more effectively in subtenon injection as compared to peribulbar injection. The subtenon anaesthesia is comparable to peribulbar anaesthesia with few additional advantages and is recommended as safe and effective alternative to peribulbar anaesthesia for cataract surgery.

Safety and efficacy of adding different doses of neostigmine as an adjuvant in peribulbar block for cataract surgery: A randomized controlled trial

ABSTRACT Background: This study aimed to evaluate safety and efficacy of adding two different doses of neostigmine to the local anesthetic lidocaine in peribulbar block anesthesia for cataract surgery. Methods: This randomized, double blind, parallel group, controlled trial (Trial registration number: IRCT20210106049952N1) included 60 patients (30–70 years-old), ASA physical status I, II, or III who were scheduled for cataract surgery. Patients received standard peribulbar block (Group C) or standard block plus 0.25 mg neostigmine (Group N25) or 0.5 mg neostigmine (Group N50). All patients were assessed for primary outcomes including hemodynamics and onsets of motor and sensory blocks. Secondary outcomes included duration of block, patient’s and surgeon’s satisfaction, postoperative pain, and time to first analgesic dose. Results: Mean onset of motor block was significantly shorter in N25 and N50 groups (72.25 ± 20.3 and 44.3 ± 10.4 sec, respectively) than in control group (110.25 ± 35.6 sec). Onset of sensory block was significantly shorter in N50 group compared to control group as well as N25 group (P < 0.001). A significantly longer mean duration of block was observed in N50 group (173.55 ± 31.09 min) in comparison to control group (79.75 ± 12.51 min) and N25 group (81.25 ± 6.25 min). Mean time till first analgesic dose showed significant differences between the three groups C, N25, and N50 (2.85 ± 0.47, 3.45 ± 1.28, and 7.1 ± 1.25 h, respectively, P < 0.001). Only two patients belonging to N50 group developed postoperative nausea and vomiting. Conclusion: Neostigmine in 0.5 mg was superior to 0.25 mg dose when added to the local anesthetic lidocaine in peribulbar anesthesia for cataract surgery regarding both sensory and motor block as well as postoperative analgesia.

Adjuvant ketorolac to peribulbar anesthesia in cataract surgery: a comparative study

Purpose The aim of this study was to evaluate the effect of adding ketorolac to peribulbar anesthesia versus conventional peribulbar anesthesia in cataract surgery. Patients and methods This is a prospective randomized comparative study that recruited patients with visually significant cataract and no other ocular or systemic conditions that may influence the ocular sensation. Patients were scheduled for phacoemulsification. They were randomly assigned into three groups. In the first group (GI), an anesthetic mixture of lignocaine, bupivacaine, hyaluronidase, and ketorolac was utilized. In the second group (GII), a mixture of lignocaine, bupivacaine, and hyaluronidase was used, whereas in the third group (GIII), a mixture of lignocaine, bupivacaine, and ketorolac was used. The onset of globe anesthesia and akinesia and the duration of globe akinesia were recorded. In addition, intraoperative pain and postoperative pain experienced by the participants were assessed using the numerical rating scale after patient instructions. Results The study included 114 patients. The onset of globe anesthesia was significantly faster in GI (6.5±1.3 min) compared with GII and GIII (8.1±1.5 and 8.8±1.9 min, respectively, P Conclusion Ketorolac was an effective adjuvant to peribulbar block. It effectively shortened the onset of globe anesthesia, with no significant effect on globe akinesia.

Comparison of outcome between single site versus double site injection of peribulbar anaesthesia for cataract surgery

To compare the efficacy and safety of single injection technique of Peribulbar anaesthesia with that of double site injection technique for cataract extraction in terms akinesia, analgesia, onset and duration of the action of analgesia and incidence of complications.A cross-sectional study involving 342 eyes which were randomised into two groups of 171 group A (single site injection peribulbar anaesthesia) and group B (double site injection peribulbar anaesthesia) by simple randomization. All the patients underwent similar protocol for standard cataract evaluation. Peribulbar anaesthesia was given in both the group before surgery and effect of anaesthesia were analysed in terms of analgesia and akinesia.Analgesia (P = 0.074) and akinesia (P = 0.054) were good in both the group but the results were not statistically significant between the 2 groups. At the end of 15 minutes all the patients attained akinesia and analgesia in both the (P= 0.053). Complications were more in group B than in group A. Single site injection of peribulbar anaesthesia is less painful during administration compared to double site peribulbar anaesthesia. Complications are more in double site injection comparatively.

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English

Efficacy and safety of ropivacaine HCl in peribulbar anaesthesia for cataract surgery in patients with myotonic dystrophy type 1.

Myotonic dystrophy (DM1) is the most common muscle disease in adults, affecting approximately 1:8000 individuals, characterized by myotonia and muscular wasting and a multisystemic involvement that includes heart, brain, respiratory and endocrine system, and eye. Conduction system is selectively involved, often causing cardiac sudden death. Early onset posterior subcapsular cataract is a characteristic feature of myotonic dystrophy, requiring surgical treatment. However, DM1 is associated with many anesthetic hazards; sensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative care. Local anesthesia also requires attention. We investigated the heart response to local anesthesia Ropivacaine Hcl administration in 16 DM1 patients (12M:4F) consecutively undergoing cataract surgery, by analyzing heart rate, ventricular and supraventricular ectopic beats, runs of tachycardia and pauses ≥ 2.5 sec., through a 24h-Holter monitoring, registered before and within 24 hours after surgery. The average age of patients was 47.4 years (range 30.2-55.9). At baseline, one patient had a pacemaker and 3 a defibrillator. Two patients presented a first-degree atrio-ventricular-block; three showed ectopic ventricular beats, on anti-arrhythmic drug treatment. No significant differences in heart rate values (73 ± 15b/m versus 76 ± 13b/m) were observed after cataract surgery, nor in the onset of ectopic beats. Only patients who presented ventricular ectopic beats at baseline, showed an increase in their number after surgery, likely related to an arbitrary interruption of the specific treatment. These data confirm the safety and efficacy of ropivacaine HCl used as a local anesthetic in patients with myotonic dystrophy.

Peribulbar Block Using Dexmedetomdine versus Magnesium Sulphate as Additives to Local Anesthetics for Cataract Surgery

Background: peribulbar block is commonly used for cataract surgery in adults, most commonly local anesthetics were injected into peribulbar space, but using only local anesthetics for peribulbar anesthesia is associated with delayed onset of globe akinesia and, short duration of analgesia and frequent need of block supplementation Objective: to assess the efficacy and safety of addition of dexmedetomidine versus magnesium sulphate to local anesthetic mixture for peribulbar block in cataract surgery. Patients and Methods: the patients were divided randomly into two equal groups: Dexmedetomidine group (D Group) included 30 patients who received 50 µg dexmedetomidine adjuvant to local anesthetics mixture (lidocaine and bupivacaine). Magnesium sulphate group (M Group) included 30 patients who received 50mg of Magnesium sulphate adjuvant to local anesthetics mixture (lidocaine and bupivacaine). Results: The addition of Dexmedetomidine or Magnesium sulphate to local anesthetic in cataract surgery accelerates the onset of corneal anesthesia and globe akinesia . The decrease in the IOP is more in D Group . No significant changes in the hemodynamic measurements in both groups Conclusion: Use of 50ug dexmedatomedine or 50mg magnesium sulphate 10% with mixture of lidocaine 2% plus bupivacine 0.5% for peribulbar anesthesia in cataract surgery enhances the onset of globe anesthesia and akinesia . Dexmedetomidine causes more decrease in intraocular pressure magnesium sulphate.

Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

PurposeTo determine the necessity of hyaluronidase as an anesthetic adjuvant for peribulbar anesthesia during cataract surgery and to assess differences in anesthetic outcomes in the absence of hyaluronidase. MethodsIn this double blinded randomized study, 202 patients reporting for surgery for senile cataract in their first eye under regional ocular anesthesia without pre-existing extra ocular movement restriction were randomly divided into 2 groups: Group 1 – anesthesia without hyaluronidase, Group 2 – anesthesia with 50 IU/ml Hyaluronidase. Peribulbar block with 5 ml of anesthetic mixture of 2% lignocaine with 1:200000 adrenaline and 0.5% bupivacaine with or without hyaluronidase was performed with 3 ml deposited in the infero-medial quadrant and 2 ml in the supero-medial quadrant followed by ocular massage. Surgeons’ score for akinesia, patients’ score for analgesia, augmentation of block if any and extra ocular movements on first post-operative day were compared between the groups. ResultsThere was no statistically significant difference between the two groups in akinesia (p = 0.22, 0.68 and 0.98), analgesia (p = 0.44 and 0.09) or requirement of anesthetic augmentation (p = 0.3). Extraocular movement restriction was not noted in any patient. Onset of akinesia and analgesia was earlier in Group 2 (p = 0.004 and p = 0.005 respectively). ConclusionsHyaluronidase is not an essential adjuvant for peribulbar block for cataract surgeries. Appropriate deposition of a smaller volume of anesthetic agent and adequate ocular massage provide adequate and safe anesthesia.

Fentanyl versus magnesium sulphate as adjuvant to peribulbar anesthesia in cataract surgery

Background and ObjectivesFentanyl or magnesium sulphate may improve the quality of peribulbar block. We compared the effects of adding either fentanyl or magnesium sulphate to peribulbar block in patients undergoing cataract surgery on the quality of globe akinesia.Methods90 adult patients undergoing cataract surgery were randomly allocated into three groups. Peribulbar block was performed by a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, hyaluronidase 150 IU diluted in normal saline to a total volume of 10 ml in control group. 20 μg fentanyl and 50 mg magnesium sulphate (10%) were added to the same mixture in fentanyl and magnesium groups respectively. Onset and duration of lid and globe akinesia, adequate time to start surgery and duration of postoperative analgesia were recorded.ResultsAddition of fentanyl significantly enhanced the onset of lid (1.54 ± 0.43 min) and globe akinesia (2.19 ± 0.75 min) as well as adequate time to start surgery (6.23 ± 1.8 min) compared to both control (P < 0.05) and magnesium sulphate (P < 0.05) groups while the comparison between control and magnesium sulphate groups was statistically insignificant (P > 0.05). Time of first analgesic request was significantly prolonged in both fentanyl and magnesium sulphate groups compared to the control group (P < 0.05).ConclusionsAddition of fentanyl (2 μg/ml) or magnesium sulphate (50 mg) to peribulbar block in patients undergoing cataract surgery equally prolongs the duration of postoperative analgesia. In addition to this effect, fentanyl fastens the onset lid and globe akinesia and provides better akinesia score.

Comparative study between a combination of lidocaine and levobupivacaine and that of lidocaine, levobupivacaine, and dexmedetomidine during peribulbar anesthesia for phacoemulsifi cation cataract surgery

Background and objective Eye surgeries are very common nowadays. Most surgeries, including cataract surgeries, can be safely performed in an outpatient setting using local anesthesia. Levobupivacaine, a levorotatory isomer of the racemic mixture of bupivacaine, has been used at regional blocks, including local eye blockades. Dexmedetomidine, a potent, highly selective and specific α2-adrenoreceptor agonist, with both sedative and analgesic effects and no respiratory depression, is used as an adjuvant to local eye anesthesia to prolong the analgesic duration of the local anesthetic used. We expected that the addition of dexmedetomidine to levobupivacaine would increase both sensory and motor block durations compared with levobupivacaine alone. Patients and methods In our study, a total of 80 patients of both sexes, aged 50–70 years, belonging to the American Society of Anesthesiologists (ASA) grade I and II, and scheduled for phacoemulsification cataract surgery were randomly allocated into one of two study groups: the levobupivacaine group (group L), in which 40 patients received 3 ml of 2% lidocaine with 10 IU/ml of hyaluronidase + 3 ml of 0.5% levobupivacaine+1 ml of normal saline; and the levobupivacaine dexmedetomidine group (group LD), in which 40 patients received 3 ml of 2% lidocaine with 10 IU/ml of hyaluronidase+3 ml of 0.5% levobupivacaine+1 ml of dexmedetomidine (100 μg). Results There was no significant difference between the two groups regarding the onset times of lid akinesia, globe anesthesia, and globe akinesia (P > 0.05). The duration of globe anesthesia, lid akinesia, and globe akinesia in the dexmedetomidine group was significantly longer than in the levobupivacaine group (P Conclusion The addition of 100 μg dexmedetomidine as an adjuvant to 2% lidocaine with 10 IU/ml of hyaluronidase and 0.5% levobupivacaine in peribulbar anesthesia for cataract surgery significantly increases the duration of peribulbar block and improves the analgesic duration, without significant side effects, and significantly decreases the intraocular pressure.

Comparison of one site and two site peribulbar anaesthesia for cataract surgery in Nigerian patients: A randomised, controlled trial

Aim: To compare the efficacy and safety of medial canthus single injection with the classic double injection peribulbar anaesthesia (PBA) technique for cataract surgery. Materials and Methods: A prospective, randomised, controlled, double-masked study was conducted at National Eye Centre, Kaduna, Nigeria between October and December 2012. One hundred patients with age-related cataracts were allocated into two equal groups. Anaesthesia was administered by an anaesthetic nurse using a mixture of xylocaine 2% + adrenaline 0.125 mg/ml + hyaluronidase 15 IU/ml with a 23G, 32 mm needle. Group 1 received a single injection into the inferomedial orbital quadrant, whereas Group 2 received two injections into the inferotemporal and superonasal quadrants. Primary outcome measures were time to achieve adequate akinesia; supplementary injections; pain of injection and surgery. Secondary outcomes were number of injections; volume of anaesthetic; complications; surgery duration; surgeon’s satisfaction. Data were analysed using the Statistical Package for the Social Sciences version 16.0 software (SPSS Inc., Chicago). Results: In each group, 82% of patients achieved adequate akinesia within 10 min of the initial injection(s). No pain was felt during the injection by 40 and 50% of patients in Groups 1 and 2, respectively; and by 96% in both groups during surgery. Chemosis occurred in 14 patients in Group 2 and none in Group 1 (P ≤ 0.001). Mean number of injections in Group 2 was 2.18 ± 0.39 versus 1.18 ± 0.39 in Group 1 (P ≤ 0.001). Median score for surgeon’s satisfaction was ‘excellent’ for both the groups. Conclusion: Single injection PBA was as good as the double injection technique in providing adequate conditions for surgery; while reducing the risks of needle-related complications.