Ropivacaine-lidocaine versus bupivacaine-lidocaine for retrobulbar anesthesia in cataract surgery

Comparing Efficacy and Safety of Intracameral Injection of Marcaine and Lidocaine on Postoperative Pain and Recovery After Cataract Surgery

Background: Various topical (intracameral) analgesics are used to relieve postoperative pain after cataract surgery. Objectives: We decided to compare the effects of intracameral Marcaine and lidocaine on pain intensity after the cataract operation. Methods: In this double-blind, randomized clinical trial, 64 patients who were candidates for cataract surgery were randomly assigned to either anesthesia with lidocaine or bupivacaine (Marcaine) by intracameral injection. Study endpoints included pain score, hemodynamic status, patient satisfaction, and recovery duration. Results: The Marcaine group experienced a shorter recovery than another group (P = 0.001). The mean pain score at the different time points after the operation was significantly lower in the group receiving Marcaine than those receiving lidocaine (P < 0.001). Our study showed a higher level of patients’ satisfaction with Marcaine as compared to the lidocaine group (P = 0.026). However, postoperative hemodynamic status was similar in both groups. Conclusions: Compared with lidocaine, intracameral injection of Marcaine results in a shorter postoperative recovery period, reduced pain intensity, and higher satisfaction among patients after cataract surgery.

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

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.

Comparison between ropivacaine and bupivacaine in deep topical fornix nerve block anesthesia in patients undergoing cataract surgery by phacoemulsification

Purpose

In this study, we intend to analyze ropivacaine and bupivacaine in various parameters during phacoemulsification under deep topical fornix nerve block (DTFNB), a known form of nerve block for phacoemulsification.

Methods

This prospective randomized study was conducted on 100 patients undergoing elective cataract surgery by phacoemulsification under DTFNB. Patients were divided into two equal groups of fifty patients each, Groups B (bupivacaine) and Group R (ropivacaine). Two sponges, approximately 2 mm × 3 mm dimensions, saturated with either 0.5% bupivacaine or 0.75% ropivacaine were placed deep in the conjunctival fornices to perform the deep topical block. Both groups were evaluated for magnitude of pain and discomfort at various stages of phacoemulsification using a simple pain scoring system. The level of surgeon satisfaction, requirement for supplementary anesthesia, and surgical complications were also evaluated. Quantitative variables between the two groups were compared using unpaired t-test. Qualitative variables were correlated using Chi-square test.

Results

Overall demographic parameters of patients were similar in both groups. Similar mean pain scores were found in the ropivacaine and bupivacaine groups, with no statistical significance. Surgical satisfaction and the need for supplemental anesthesia were also statistically insignificant.

Conclusion

Ropivacaine is a good alternative for deep topical anesthesia as it has a better safety margin and lesser toxic effect than other comparable local anesthetic agents.

Ropivacaine versus lidocaine for deep-topical, nerve-block anaesthesia in cataract surgery: a double-blind randomized clinical trial

PURPOSE

To evaluate the safety and efficacy of ropivacaine versus lidocaine for deep-topical, nerve-block anaesthesia in cataract surgery.

METHODS

This prospective controlled randomized double-blind study comprised 64 patients undergoing clear corneal phacoemulsification. Patients were equally divided into two group receiving either deep-topical anaesthesia with 1% ropivacaine-soaked sponge (Group R, n = 32) or 2% lidocaine-soaked sponge (Group L, n = 32). The level of intraoperative and postoperative pain was assessed by patients using a verbal analogue scale from 1 to 10. The duration of surgery, the need for supplemental anaesthesia, surgeon satisfaction, and intraoperative and early postoperative complications were recorded. The patients' heart rate, arterial blood pressure and peripheric oxygen saturation (SpO(2)) were obtained just before the anaesthesia and during the surgery.

RESULTS

The demographic data of the patients and duration of surgery were similar in both groups. No significant difference in the mean pain scores of patients were found in the ropivacaine and lidocaine groups. Surgical satisfaction was also statistically insignificant. None of the patients had significant difference in heart rate, blood pressure or SpO(2) during the surgical procedure.

CONCLUSION

Deep-topical anaesthesia with ropivacaine and lidocaine in cataract surgery is safe and the two anaesthetic agents do not present differences in the degree of analgesia achieved. Deep-topical anaesthesia with ropivacaine or lidocaine was equally effective in providing anaesthesia with sufficient quality for cataract surgery.

Benefit-Risk Assessment of Ropivacaine in the Management of Postoperative Pain

Ropivacaine is a long-acting amide-type local anaesthetic, released for clinical use in 1996. In comparison with bupivacaine, ropivacaine is equally effective for subcutaneous infiltration, epidural and peripheral nerve block for surgery, obstetric procedures and postoperative analgesia. Nevertheless, ropivacaine differs from bupivacaine in several aspects: firstly, it is marketed as a pure S(-)-enantiomer and not as a racemate, and secondly, its lipid solubility is markedly lower. These features have been suggested to significantly improve the safety profile of ropivacaine, and indeed, numerous studies have shown that ropivacaine has less cardiovascular and CNS toxicity than racemic bupivacaine in healthy volunteers. Extensive clinical data have demonstrated that epidural 0.2% ropivacaine is nearly identical to 0.2% bupivacaine with regard to onset, quality and duration of sensory blockade for initiation and maintenance of labour analgesia. Ropivacaine also provides effective pain relief after abdominal or orthopaedic surgery, especially when given in conjunction with opioids or other adjuvants. Nevertheless, epidurally administered ropivacaine causes significantly less motor blockade at low concentrations. Whether the greater degree of blockade of nerve fibres involved in pain transmission (Adelta- and C-fibres) than of those controlling motor function (Aalpha- and Abeta-fibres) is due to a lower relative potency compared with bupivacaine or whether other physicochemical properties or stereoselectivity are involved, is still a matter of intense debate. Recommended epidural doses for postoperative or labour pain are 20-40 mg as bolus with 20-30 mg as top-up dose, with an interval of >or=30 minutes. Alternatively, 0.2% ropivacaine can be given as continuous epidural infusion at a rate of 6-14 mL/h (lumbar route) or 4-10 mL/h (thoracic route). Preoperative or postoperative subcutaneous wound infiltration, during cholecystectomy or inguinal hernia repair, with ropivacaine 100-175 mg has been shown to be more effective than placebo and as effective as bupivacaine in reducing wound pain, whereby the vasoconstrictive potency of ropivacaine may be involved. Similar results were found in peripheral blockades on upper and lower limbs. Ropivacaine shows an identical efficacy and potency to that of bupivacaine, with similar analgesic duration over hours using single shot or continuous catheter techniques. In summary, ropivacaine, a newer long-acting local anaesthetic, has an efficacy generally similar to that of the same dose of bupivacaine with regard to postoperative pain relief, but causes less motor blockade and stronger vasoconstriction at low concentrations. Despite a significantly better safety profile of the pure S(-)-isomer of ropivacaine, the increased cost of ropivacaine may presently limit its clinical utility in postoperative pain therapy.