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

Abstract

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 > 0.52). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (p > 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.