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.

Table 3: Typical onset times and other properties of traditional (0.5% bupivacaine+2% lidocaine), and new (ropivacaine, levobupivacaine, 2-choloroprocaine and articaine) local anaesthetic agents.