Anaesthetic agent |
Onset time
[to akinesia or time to start surgery] (min) |
Remarks |
Bupivacaine [38,104]
[Peribulbar approach]
50:50 mixture of
0.5% bupivacaine
(with 1:200,000 epinephrine
+ 30 IU/mL hyaluronidase)
& 2% lidocaine |
7.2
(5.7 standard
deviation) |
i) Bupivacaine is cardiotoxic
ii) No adverse effects due to diplopia. (However some reports suggest diplopia not resolved until next day). |
Ropivacaine [105]
Comparative study:
[Peribulbar approach]
Ropivacaine
+ 2% lidocaine
+ hyaluronidase
vs.
Bupivacaine
+2% lidocaine
+ hyaluronidase |
8.0 (median)
for both agents |
i) Ropivacaine: less cardiotoxic than bupivacaine, also it has higher threshold for central nervous system toxicity.
ii) Concentration effect of (Ropivacaine
+ hyluronidase):
The recovery of motor function after
a) 15min: 55% & 82% for 0.5% and 0.75% ropivacaine respectively.
b) 60 min: 37%& 5% for 0.5% and 0.75% ropivacaine respectively.
c) Diplopia persisted for 30 hours for 1% ropivacaine |
Levobupivacaine [106]
Comparative study:
a) [sub-Tenon’s approach]
0.75% levobupivacaine
+ hyaluronidase
vs.
2% lidocaine
+ hyaluronidase
b) [Peribulbar approach]
o.75% levobupivacaine
+hyaluronidase
Vs
0.75% bupivacaine
+hyaluronidase |
5.06
3.02
2.0 (median)
2.0 (median) |
Levobupivacaine is of reduced cardiotoxicity
(For (a), the onset difference between 0.75% levobupivacaine and 2% lidocaine is reported as not clinically significant [39]) |
2-Choloroprocaine [107]
Comparative study:
[Peribulbar approach]
2% 2-choloroprocaine
vs.
3% 2-choloroprocaine
(both preservative free) |
<4
6 |
The full recovery of extraocular muscle and eye lid motion was:
<85 min for 2% 2-choloroprocaine, and
<100min for 3% 2-choloroprocaine |
Articaine [108]
Comparative study:
a) [Peribulbar approach]
2% articaine
+1:200,000 epinephrine
+hyaluronidase
vs.
0.5% Bupivacaine
+ 2% lidocaine
+ hyaluronidase
b) Repeat of a) in
[inferotemporal injection
approach]
c) [sub-Tenon’s approach]
2% articaine
vs.
0.5% bupivacaine
+ 2% lidocaine |
[Degree of ocular akinesia (in peribulbar approach)]:
i) After 1-min: Same for both 2% articaine and 0.5% bupivacaine.
ii) After 5-min: degree of akinesia greater for 2% articaine
compared to 0.5% bupivacaine.
iii) At discharge: the regain of extraocular motion quicker for 2% articaine
compared to 0.5% bupivacaine.
In inferotemporal approach, the onset times same as above (i.e. for peribulbar
approach)
In sub-Tenon’s approach, 2% articaine
had faster onset times compared to 0.5% bupivacaine. |