title: Comparison of articaine and bupivacaine/lidocaine for single medial canthus peribulbar anaesthesia.
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.
authors.affiliation: Department of Anaesthesia, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: K G
authors.initials: KG
authors.lastname: Allman
authors.forename: J G
authors.initials: JG
authors.lastname: McFadyen
authors.forename: J
authors.initials: J
authors.lastname: Armstrong
authors.forename: G D
authors.initials: GD
authors.lastname: Sturrock
authors.forename: I H
authors.initials: IH
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D001767:Blinking / Q000187:drug effects; D002045:Bupivacaine; D002355:Carticaine; D002387:Cataract Extraction; D004311:Double-Blind Method; D004837:Epinephrine; D005133:Eye Movements / Q000187:drug effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008012:Lidocaine; D008297:Male; D008875:Middle Aged
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D002355:Carticaine; D002045:Bupivacaine; D004837:Epinephrine