Author(s): Allman KG, McFadyen JG, Armstrong J, Sturrock GD, Wilson IH
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Abstract In a single-centre, randomized, double-blind study, we compared the efficacy of 2\% articaine with that of a mixture of 0.5\% bupivacaine and 2\% lidocaine for peribulbar anaesthesia in cataract surgery, using a single medial canthus injection technique. Eighty-two patients were allocated randomly to receive 7-9 ml of a mixture of 0.5\% bupivacaine and 2\% lidocaine or an equal volume of 2\% articaine with 1:200,000 epinephrine. Hyaluronidase 30 iu ml(-1) was added to both solutions. The degree of akinesia was scored 1, 5 and 10 min after the block, at the end of surgery and at discharge from the day case unit. Primary outcome measures were the difference in ocular movement scores 5 min after block and the need for supplementary inferolateral injections. There was greater akinesia in the articaine group at 5 min (P=0.01). Ten patients (24\%) in the articaine group and 21 patients (51\%) in the bupivacaine/lidocaine group required a supplementary injection (P=0.02). The mean (SD) volume of local anaesthetic required to achieve adequate block for surgery was 9.7 (2.1) ml in the articaine group and 11.0 (2.2) ml in the bupivacaine/lidocaine group (P=0.01). There was a faster offset of akinesia after surgery in the articaine group (P=0.01). There were no differences between groups in the incidence of reported pain or of minor complications. In our study, 2\% articaine with 1:200,000 epinephrine was safe and efficacious for single medial canthus peribulbar anaesthesia.
This article was published in Br J Anaesth
and referenced in Journal of Clinical & Experimental Ophthalmology