Peribulbar Block For Cataract Surgery Research Articles

Peribulbar Block for Cataract Surgery in Patient with Nystagmus and Chronic Kidney Disease

Background: Management of presenile cataracts with nystagmus and chronic kidney (CKD) disease is a separate problem in anesthetic procedures. The risk of anesthesia in patients with chronic kidney disease is accumulation of nephrotoxic metabolites, unstable hemodynamic during intraoperative, and fluid overload.Case: A 43-year-old man with a diagnosis of immature presenile cataract with nystagmus and comorbid CKD was planned for phacoemulsification and intraocular lens. The anesthetic technique used was regional anesthesia with peribulbar block. Site injections in the inferotemporal and medial canthus with local anesthetic drugs levobupivacaine 0.5% 5 ml and lidocaine 2% 3 ml.Discussion: Combination of peribulbar block and mild sedation provides effective analgesic and anxiolytic effects. Peribulbar blocks in nystagmus besides sensory blocks can also block motoric function so that the position of the eyeball is in center.Conclusion: The peribulbar blockade anesthetic technique can be considered as an alternative safe anesthetic technique for cataract surgery with nystagmus and CKD.

Comparison between dexmedetomidine and neostigmine as an adjuvant to bupivacaine and lidocaine in peribulbar block for cataract surgery.

Comparison between dexmedetomidine and neostigmine as an adjuvant to bupivacaine and lidocaine in peribulbar block for cataract surgery.

Evaluation of efficacy of peribulbar block with the combination of 2% lidocaine and 0.5% bupivacaine in comparison with 2% lidocaine and 0.75% ropivacaine in cataract surgery.

Cataract surgery is performed under peribulbar or retrobulbar block. Majority of the patients posted for cataract have some form of medical diseases like diabetes, hypertension, angina, ischaemic heart disease etc. Lidocaine and bupivacaine are the most commonly used local anesthetic for the block procedure. Here we compare the efficacy of peribulbar block in cataract surgery using the combination of 1:1 mixture of 2% lidocaine with 0.5% bupivacaine and 1:1 mixture of 2% lidocaine with 0.75% ropivacaine. It is a prospective, randomized, double blinded study including 60 patients were devided into two groups of 30 each, Group-R received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0.75% ropivacaine and 15 IU/ml of hyaluronidase and group-B received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0. 5% bubivacaineand 15 IU/ml of hyaluronidase. Peribulbar block was performed as per Bloomberg's modification of the Davis and Mandel technique where 5 ml of local anesthetic was injected in the infero temporal region and 3 ml of drug was injected in the superi nasal area. Patients were assessed for sensory block, eyelid and occular movements at an interval of 2 minutes. Systolic, diastolic and mean arterial pressures, heart rate, oxygen saturation, ECG were monitored non invasively at 1,3,5,8,10,15 and then every 10 minutes till the end of the surgery. Mean time for the onset of sensory blockade was 2.70 ± 6.5 minutes in Group B and 2.63 ± 0.57 minutes in group R with P-value 0.671, showing no significant difference in the onset of sensory blockade. Onset of motor blockade was 6.53 ± 1.81 minutes in group B, and 7.57 ± 1.46 minutes in the group R, the P-value being 0.018 was statistically significant. Regarding the duration of analgesia, our study showed mean time for analgesia lasted for 295 ± 54.63 minutes in group B and 414.67 ± 99.47 in group R with P value 0.001 showing statistically significant prolongation of duration of analgesia with group R. We observed a significant increase of mean IOP in bupivacaine group from 13.333 ± 1.582 mm Hg to 21.966 ± 2.697 mm Hg, whereas in ropivacaine group it increased from 12.766 ± 1.222 mm Hg to 13.0 ± 1.341 mm Hg after peribulbar anaesthesia.

A Rare Case of Hyphema in Fuchs Heterochromic Iridocyclitis After Peri-bulbar Block for Cataract Surgery

We report a case of 47 year old male patient with Fuchs heterochromic iridocyclitis and cataract in left eye who developed hyphema after peri-bulbar block for cataract surgery. The patient developed Amsler like Sign. It appeared few minutes after Peri-bulbar block following digital massage before any instrumentation of the globe. Surgery was post-poned to rule out globe perforation or any other pathology for Anterior Chamber bleed. All possible causes were ruled out and patient was eventually taken up for Cataract Surgery which was uneventful without any intra-op or post-op 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<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>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<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

Brainstem anesthesia: A rare complication after peribulbar anesthesia

Brainstem anesthesia (BSA) is a rare but serious complication of the peribulbar block. Fewer than ten cases have been reported in the literature. We report a case of BSA after the peribulbar block for cataract surgery. The patient developed convulsion and respiratory arrest 5 min after injection of 7 ml of 2% lignocaine using a 25 ml (mm) length of 24 gauge (G) needle. The patient was successfully managed with prompt recognition and mechanical ventilation for about 1 h. Cataract surgery was performed 3 months after the adverse event. This time, the patient had an uneventful recovery. The patient was well at the 6-month follow-up.

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.

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.

A comparative study between levobupivacaine 0.5% plus lignocaine 2% or bupivacaine 0.5% plus lignocaine 2% for peribulbar block in cataract surgery

Background and Aim: Local anesthetic techniques are increasingly popular for ophthalmic surgery. Levobupivacaine, the pure S (-) enantiomer of bupivacaine, has strongly emerged as a safer alternative for regional anesthesia than its racemic sibling, bupivacaine. The present Study was performed with an aim to compare between levobupivacaine 0.5% or bupivacaine 0.5% both in a mixture with lignocaine 2% for peribulbar block in cataract surgery.Methodology: In this prospective double blind study, all the patients were randomly divided in two groups, Group B patients received inj bupivacaine 0.5% (5 ml) + lignocaine 2% (5 ml) + hyaluronidase (5 IU/ml), and Group L patients received inj levobupivacaine 0.5% (5 ml) + lignocaine 2% (5 ml) + hyaluronidase (5 IU/ml) for peribulbar block by akinetic technique to provide anesthesia for cataract surgery. The study was conducted for the period of one year. After routine pre anesthetic assessment, a peripheral intravenous (i.v.) line was inserted in 6 hours fasted patient and standard monitoring was conducted and recorded, including heart rate (HR), noninvasive arterial blood pressure (BP), electrocardiogram (5 leads), and peripheral oxygen saturation (SpO2). Motor block was evaluated by assessment of akinesia in four quadrants using general akinesia scoring system. Results: There were no significant difference between groups with respect to the akinesia score (p = 0.24) at 2, 5 and 10 min, the number of supplementary injections (p = 0.83) and initial and total required volume of local anesthetics (p = 0.78 and p = 0.79). There was no significant difference between the groups regarding surgeon and patient satisfaction (p &gt; 0.52). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (p &gt; 0.05). The need for additional intra-operative topical anesthetic was similar between the groups (p = 0.64).Conclusion: Peribulbar block with a mixture of levobupivacaine 0.5% and lignocaine 2% or bupivacaine 0.5% and lignocaine 2% provides similar block quality and efficacy.Citation: Shah J, Bhatt KA. A comparative study between levobupivacaine 0.5% plus lignocaine 2% or bupivacaine 0.5% plus lignocaine 2% for peribulbar block in cataract surgery. Anaesth pain &amp; intensive care 2019;23(2):192-197

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.

Comparative Study between Effects of Addition of Fentanyl versus Dexmedetomidine to Local Anesthetic Mixture for Peribulbar Block for Cataract Surgery

Background: regional anesthesia is currently more preferable than general anesthesia in ophthalmic surgery and include many types as; peribulbar (extraconal) and retrobulbar (intraconal) anesthesia. Peribulbar block is commonly used because there is reduced risk of globe perforation and optic nerve damage in different to retrobulbar block, but it needs sometimes block supplementations to improve the quality of the block such as clonidine and hyaluronidase. Also, fentanyl and dexmedetomidine was added in this study as an adjuvant to local anesthetics in peribulbar block for cataract surgery. Objective: the aim of this study was to evaluate and compare the effect of adding fentanyl and dexmedetomidine as adjuvants to local anaesthetic mixture in peribulbar block as regards duration (anesthesia and akinesia), efficacy and pain relief. Patients and Methods: in this study sixty patients of ASA I-III of both gender, aged 30-60 years arranged into three equal groups (group S, group F and group D) received peribulbar block for phacoemulsification with intraocular lens implantation operation. Group F and group D received fentanyl and dexmedetomidine respectivly with local anaethetics (LA) solution and showed statistically significant difference in onset and duration of globe akinesia respectively compared to group C which received local anaethetics (LA) solution only. Results: the onset of globe analgesia was significant in group F and group D compared to Group S. Postoperative pain was assessed by using a 5-points verbal rating score and recorded data showed significant difference between the three groups with better postoperative pain control in group F and group D. There was no statistical significant difference between the two groups as regarding the hemodynamics (MBP, HR and SPO2) and the incidence of complications. Conclusion: the current study concluded that adding fentanyl or Dexmedetomidine to local anaethetics (LA) in peribulbar block significantly reduced the time of onset of globe akinesia and analgesia and reduced the need for second injection. Also, it increased the duration of globe akinesia and analgesia with better postoperative pain control.

Comparative Study between Effects of Addition of Fentanyl versus Dexmedetomidine to Local Anesthetic Mixture for Peribulbar Block for Cataract Surgery

Comparative Study between Effects of Addition of Fentanyl versus Dexmedetomidine to Local Anesthetic Mixture for Peribulbar Block for Cataract Surgery

Postoperative analgesia of ultra-low-dose naloxone versus dexmedetomidine with local anesthetic in peribulbar block in cataract surgery

Background and aim Regional anesthesia in eye surgery is a preferred technique and widely used in all eye surgery centers. It is safe, inexpensive, simple, and reliable and provides efficient ocular anesthesia. It is associated with less complications than general anesthesia. Among regional blocks, peribulbar block is safer in comparison with retrobulbar block owing to lesser incidence of complications such as retrobulbar hemorrhage, globe perforation, and brain stem anesthesia, but it has some disadvantages such as incomplete orbital and eyelid akinesia and decrease time of analgesia in which the patient need pain relief postoperatively, so many adjuvant drugs have been added to local anesthetic to overcome these disadvantages. Dexmedetomidine is a central-acting drug, a highly selective α2-agonist, that has been used as an additive to local anesthetic, whereas the mechanism of action of ultra-low-dose naloxone includes inhibition of impulses of the excitatory opioid receptors and release of encephalin. The goal of this study was to assess the effect of ultra-low-dose naloxone and dexmedetomidine as adjuvants for local anesthetic on duration of analgesia as primary outcome and akinesia of the globe and eyelid and occurrence of complications as a secondary outcome. Patients and methods A total of 60 patients were included in this prospective randomized double-blind clinical study scheduled for elective cataract surgery, who were randomly divided into two groups: N group (n=30) received 3.5 ml of lidocaine 2%, 3.5 ml of bupivacaine 0.5% with 15 IU/ml hyaluronidase for both lidocaine and bupivacaine, and 100 ng naloxone in 1 ml normal saline. D group (n=30) received 3.5 ml of lidocaine 2%, 3.5 ml of bupivacaine 0.5% with 15 IU/ml hyaluronidase for both lidocaine and bupivacaine and 25 μg of dexmedetomidine in one-ml normal saline. The assessment includes duration of analgesia (h), which is the time from injection till visual analog scale of more than 4 or request of analgesia by the patient, akinesia of the globe and eyelid assessed every 2 min using a three-point scale, and occurrence of complications (pain during injection, chemosis, diplopia, bradycardia, and hypotension). Results A total of 60 cataract surgery patients were included in the study. Regarding primary outcome (duration of analgesia), we found a highly statistically significant difference in duration of analgesia, with longer duration of analgesia in N group of patients compared with D group (P Conclusion The addition of ultra-low-dose naloxone to local anesthetic in cataract surgery shows longer duration of analgesia.

The effect of adding cisatracurium versus hyaluronidase to levobupivacaine and lidocaine mixture in single injection peribulbar block for cataract surgery

BackgroundSeveral adjuvants can be utilized to improve the quality of peribulbar block (PBB). We compared the effects of adding cisatracurium or hyaluronidase to levobupivacaine and lidocaine mixture for PBB on the onset of globe and lid akinesia in cataract surgery.Methods105 adult patients scheduled for cataract surgery under PBB were randomly allocated into three groups. Control group received 4 ml 0.5% levobupivacaine plus 3 ml 2% lidocaine diluted in saline to a total volume of 8 ml. Hyaluronidase 15 IU/ml and cisatracurium 1 mg were added to local anesthetics (LAs) mixture in hyaluronidase and cisatracurium groups respectively. Onset and duration of lid and globe akinesia, time for adequate conditions to start surgery and adverse events were recorded. Distribution of LAs solution was evaluated by B-scan ultrasound at 3 min and 10 min after injection of LAs.ResultsOnset of lid and globe akinesia, as well as time to adequate conditions to start surgery, were faster in cisatracurium and hyaluronidase groups compared to the control group (P < 0.05). Cisatracurium group had the fastest onset. At 3 min after injection of LAs, the ultrasound examination revealed that hyaluronidase group had the highest percentage of patients showing intraconal diffusion of LAs solution with the appearance of a characteristic T sign (P < 0.05).ConclusionsThe addition of cisatracurium 1 mg or hyaluronidase 15 IU/ml to levobupivacaine and lidocaine mixture for PBB hastened the onset of lid and globe akinesia without increase the incidence of adverse effects. This effect is more obvious with cisatracurium compared to hyaluronidase.

Study of Dexmedetomidine as an Adjuvant to Local Anesthetics in Peribulbar Block for Cataract Surgery

Study of Dexmedetomidine as an Adjuvant to Local Anesthetics in Peribulbar Block for Cataract Surgery

Effect of the addition of rocuronium to 2% lignocaine in peribulbar block for cataract surgery.

Background and Aims:Peribulbar anesthesia is associated with delayed orbital akinesia compared with retrobulbar anesthesia. To test the hypothesis that rocuronium added to a mixture of local anesthetics (LAs) could improve speed of onset of akinesia in peribulbar block (PB), we designed this study. This study examined the effects of adding rocuronium 5 mg to 2% lignocaine with adrenaline to note orbital and eyelid akinesia in patients undergoing cataract surgery.Material and Methods:In a prospective, randomized, double-blind study, 100 patients were equally randomized to receive a mixture of 0.5 ml normal saline, 6 ml lidocaine 2% with adrenaline and hyaluronidase 50 IU/ml (Group I), a mixture of rocuronium 0.5 ml (5 mg), 6 ml lidocaine 2% with adrenaline and hyaluronidase 50 IU/ml (Group II). Orbital akinesia was assessed on a 0–8 score (0 = no movement, 8 = normal) at 2 min intervals for 10 min. Time to adequate anesthesia was also recorded. Results are presented as mean ± standard deviation.Results:Rocuronium group demonstrated significantly better akinesia scores than control group at 2 min intervals post-PB (significant P value obtained). No significant complications were recorded. Rocuronium added to a mixture of LA improved the quality of akinesia in PB and reduced the need for supplementary injections.Conclusion:The addition of rocuronium 5 mg to a mixture of lidocaine 2% with adrenaline and hyaluronidase 50 IU/ml shortened the onset time of peribulbar anesthesia in patients undergoing cataract surgery without causing adverse effects.

The Effect of Adding Two Different Doses of Magnesium Sulphate as Adjuvant to Ropivacaine in Peribulbar Block for Cataract Surgery

Background: This study was designed to compare the effects of adding two different doses of magnesium sulphate to the local anesthesia during peribulbar block. Patients and methods: The study comprised 105 patients undergoing cataract surgeries. The patients were divided randomly into three groups (35 patients in each group): Group I (Control group): patients received peribulbar anesthesia using a mixture of 6 ml of 0.5% ropivacaine, 1 ml (150 IU) hyaluronidase and 1 ml of normal saline, Group II (Mg 50): patients received peribulbar anesthesia using a mixture of 6 ml of 0.5% ropivacaine, 1 ml (150 IU) hyaluronidase and 50 mg of magnesium sulphate in 1 ml saline and Group III (Mg 100): patients received peribulbar anesthesia using a mixture of 6 ml of 0.5% ropivacaine, 1 ml (150 IU) hyaluronidase and 1 ml of 100 mg magnesium sulphate. Corneal sensation and motor block were evaluated, total amount of local anesthetic, duration sensory and motor block were assessed, analgesia was assessed by using visual analogue score (VAS) at the end of surgery, 1 h, 2 h, 4 h and 6 h. Statistical analysis was done using ANOVA test, Kruskal Wallis test And Chi-square test (χ2) to study association between qualitative variables. Whenever any of the expected cells were less than five, Fischer’s Exact test with Yates correction was used. P- value of <0.05 was considered statistically significant. Results: Patients received magnesium sulphate showed significantly rapid onset of lid and globe akinesia (P<0.0001) and significantly prolonged duration of akinesia than the control (P<0.0001). First analgesic requirement is significantly delayed in group II and group III comparison with the control group (group I) (P<0.0001). There were statistically significant differences between the three groups as regard the mean VAS in 4 and 6 hours, group II and group III have lower median pain score than group I (control group) (P<0.0001). Conclusion: Addition of 50 mg or 100 mg of magnesium sulfate to ropivacaine in peribulbar block led to rapid onset and prolonged the duration of sensory and motor blockade without adverse effects with reduction of the postoperative analgesic requirements. The results were more significant on using 100 mg magnesium sulfate.

Comparing different fentanyl concentrations added to local anesthetic mixture in peribulbar block for cataract surgery

ObjectiveEvaluation of the effect of different concentrations of fentanyl added to the local anesthetic mixture on the onset and duration of globe anesthesia, after peribulbar block, with the least side effects.DesignDouble blinded randomized controlled clinical trial.SettingKasr Al Aini hospital, Cairo University.Methods60 patients with cataract grade 1–3 in the age group 40–70 years, with American Society of Anesthesiologists (ASA) grade I, II and III, scheduled for elective cataract surgery under regional anesthesia. They were randomly divided into four groups: in Group 1 (Control Group), patients received Lidocaine 2% and Hyaluronidase 15 IU/ml; in Groups 2, 3 and 4 (Fentanyl Groups), the patients received Lidocaine 2% and Hyaluronidase 15 IU/ml in addition to Fentanyl 1 μg/ml, 2 μg/ml and 3 μg/ml respectively. The onset and duration of lid and globe akinesia were assessed. Postoperative Visual Analogue Score was recorded each hour up to 6 h.ResultsNo statistical significant difference was observed between the four groups in the onset and duration of lid and globe akinesia. There was a significant difference between the control group and the fentanyl groups as regards the duration of analgesia that was significantly prolonged in the groups that received fentanyl at concentrations of 2 μg/ml and 3 μg/ml in these group patients required analgesia after 116 ± 19 min and 144 ± 11 min respectively compared to the control group and the group that received fentanyl at a concentration of 1 μg/ml group who required analgesia after 100–103 min.ConclusionAdding Fentanyl at concentrations ⩾ 2–3 μg/ml to the local anesthetic mixture (Lidocaine and Hyaluronidase) for regional peribulbar block provides safe and effective method in improving postoperative analgesia in patients undergoing cataract surgery.

Dexmedetomidine as an additive to local anesthetics compared with intravenous dexmedetomidine in peribulbar block for cataract surgery.

Background:No studies compared parenteral dexmedetomidine with its use as an adjuvant to ophthalmic block. We compared between adding dexmedetomidine to bupivacaine in peribulbar block and intravenous (IV) dexmedetomidine during peribulbar block for cataract surgery.Materials and Methods:A prospective, randomized, double-blind study on 90 patients for cataract surgery under peribulbar anesthesia. Study included three groups; all patients received 10 ml of peribulbar anesthesia and IV infusion of drugs as follows: Group I: Received a mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) + 150 IU hyaluronidase + IV infusion of normal saline, Group II: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + dexmedetomidine 50 μg (1 ml) +150 IU hyaluronidase + IV infusion of normal saline and Group III: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) +150 IU hyaluronidase + IV dexmedetomidine 1 μg/kg over 10 min; followed by 0.4 μg/kg/h IV infusion. We recorded onset, duration of block, Ramsay Sedation Score, intra-ocular pressure (IOP), hemodynamics, and adverse effects.Results:There was a significant decrease in the onset of action and increase in the duration of block in Group II as compared with the Group I and Group III. Mean Ramsay Sedation Score was higher in Group III. The IOP showed a significant decrease in Group II and Group III 10 min after injection (P < 0.01). Heart rate showed a significant decrease in Group III in comparison with the two other groups (P < 0.05). Only two patients in Group III developed bradycardia.Conclusion:Dexmedetomidine as an additive shortens onset time, prolong block durations and significantly decreases the IOP with minimal side effects. IV dexmedetomidine, in addition, produces intra-operative sedation with hemodynamic stability.

Comparison of orbital muscle akinesia caused by rocuronium versus hyaluronidase mixed to the local anesthetic in single injection peribulbar block for cataract surgery.

Background:The aim of this study was to compare orbital muscle akinesia caused by rocuronium versus hyaluronidase when mixed with the local anesthetic in single-injection peribulbar anesthesia (PBA).Patients and Methods:Sixty patients were included in the study and subjected to cataract extraction using phacoemulsification technique with intraocular lens implantation. Group I received peribulbar block with 5 ml mixture of 30 IU/ml hyaluronidase and 2% lidocaine. Group II received peribulbar block with 5 ml mixture of rocuronium 5 mg and 2% lidocaine. The onset and duration of akinesia were assessed; the akinesia score at 2, 5, and 10 min was measured after injection. The need for supplementary injection was also recorded.Results and Conclusion:PBA using a mixture of rocuronium and lidocaine provides optimal globe akinesia and faster establishment of suitable conditions to start eye surgery and shortens the block onset time as compared with the addition of hyaluronidase to lidocaine.