Efficacy and comparison of 0.5% levobupivacaine with 0.75% ropivacaine for peribulbar anaesthesia in cataract surgery.
OBJECTIVE
The low cardiovascular and neurological toxicity of levobupivacaine has led to its application as a local anaesthetic in a wide variety of specialist applications including peribulbar block for cataract surgery. The aim of this study was to evaluate the efficacy of levobupivacaine 0.5% and to compare block quality vs. ropivacaine 0.75% in peribulbar anaesthesia.


METHODS
We examined 208 patients subjected to cataract surgery by phacoemulsification who were randomized into two groups according to the anaesthetic used for peribulbar block, namely levobupivacaine 0.5% or ropivacaine 0.75%, both with the addition of hyaluronidase. Nerve block was carried out by injection of 6 mL of the anaesthetic mixture equally distributed between the inferotemporal and superonasal areas. The success of the block was evaluated by determining the time of motor and sensory onset, akinesia score, times of motor and sensory offset and satisfaction of the patient and surgeon after 24 h. Pre-block, post-block and postoperative intraocular pressure as well as the duration of surgical intervention was also determined.


RESULTS
With respect to ropivacaine, levobupivacaine showed a significant reduction (P < 0.001) in the average motor and sensory onset. Both the akinesia score (P < 0.01) and mean motor and sensory offset times were also higher (P < 0.001). Neither the average intervention times nor the satisfaction of the patient/surgeon showed any significant differences between the two groups.


CONCLUSIONS
Levobupivacaine (0.5%) has better anaesthetic properties with respect to 0.75% ropivacaine and is well-suited for peribulbar block in cataract surgery.
Di Donato
A
A
Department of Anaesthesia, Intensive Care and Pain Management, Military Policlinic, Concordia Hospital for Special Surgery, Winnipeg, Manitoba, Canada. attilio.didonato@fastwebnet.it
Fontana
C
C
Lancia
F
F
Celleno
D
D
D000368:Aged; D000577:Amides / Q000627:therapeutic use*; D000704:Analysis of Variance; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000627:therapeutic use; D002387:Cataract Extraction / Q000379:methods*; D015331:Cohort Studies; D004311:Double-Blind Method; D005123:Eye / Q000187:drug effects; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007429:Intraocular Pressure / Q000187:drug effects; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000379:methods*; D017060:Patient Satisfaction; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D000077554:Levobupivacaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine