J Korean Ophthalmol Soc.  2021 Dec;62(12):1600-1606. 10.3341/jkos.2021.62.12.1600.

Bupivacaine-lidocaine versus Ropivacaine-lidocaine Retrobulbar Anesthesia in Vitreoretinal Surgery

• Choi YA
• Jeong A
• Sagong M

• KMID: 2523313
• DOI: http://doi.org/10.3341/jkos.2021.62.12.1600

Abstract

Purpose
To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy.
Methods
Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded.
Results
The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade.
Conclusions
When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.

Keyword

Bupivacaine, Pain, Retrobulbar anesthesia, Ropivacaine, Vitrectomy