A comparison of mepivacaine versus lidocaine for episcleral (sub-tenon's) block for cataract surgery in an ambulatory setting.
OBJECTIVE
For eye surgery, motor block is still often requested by the surgeon. For cataract surgery, rapid block resolution allows eyelids to move and allows eye-patch removal. Therefore, short-duration block is useful in early rehabilitation for ambulatory surgery. Lidocaine is classically assumed to have shorter duration than mepivacaine. Therefore, lidocaine alone might be considered as an alternative to mepivacaine.


METHODS
In this randomized, double-blind study, we compared mepivacaine 2% (n = 22) and lidocaine 2% (n = 25) in 47 patients who received episcleral (sub-Tenon's) block for cataract surgery. Akinesia score was measured 1, 5, 10, and 15 minutes and 1, 2, 4, and 6 hours after the end of injection. Primary outcome was block duration (time from injection to full recovery). Secondary outcomes were time to block onset and best akinesia score for each patient. Complications were recorded.


RESULTS
The 2 groups were similar for demographic and anesthetic features. We observed no significant difference between mepivacaine and lidocaine in terms of onset, quality of akinesia, and block duration. One case of ocular hypertonia and 1 case of strabismus were observed in the lidocaine group, which could be imputed to hyaluronidase unavailability during the study period or to increased lidocaine myotoxicity.


CONCLUSIONS
We found no argument to favor lidocaine over mepivacaine in episcleral (sub-Tenon's) eye block, especially in terms of motor-block duration.
Ripart
Jacques
J
Anesthesia Department, Anesthesia-Emergency Division, Centre Hospitalier Universitaire de Nimes, Nimes, France. jacques.ripart@chu-nimes.fr
Nouvellon
Emmanuel
E
Chaumeron
Arnaud
A
Chanial-Bourgaux
Catherine
C
Mahamat
Aba
A
D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002387:Cataract Extraction; D004311:Double-Blind Method; D005123:Eye / Q000187:drug effects / Q000294:innervation; D005133:Eye Movements; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009407:Nerve Block; D013997:Time Factors
D000779:Anesthetics, Local; D008012:Lidocaine; D008619:Mepivacaine