title: Local anesthetic agents for vitreoretinal surgery: no advantage to mixing solutions.
abstract: OBJECTIVE
  To compare the efficacy of lidocaine, bupivacaine, and a mixture of both in patients undergoing peribulbar anesthesia for vitreoretinal surgery.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Ninety patients.
  
  
  METHODS
  Patients who underwent vitreoretinal surgery were randomized into 3 groups based on the peribulbar injection they received: lidocaine, bupivacaine, or a combination of lidocaine and bupivacaine.
  
  
  METHODS
  Time of onset of analgesia, akinesia, and intraoperative pain, if any, was noted. The efficacy of the block was graded from 0 to 5 depending on the adequacy of anesthesia and akinesia and the need for local supplementation.
  
  
  RESULTS
  Mean times of onset (± standard deviation) of sensory blockade for the lidocaine, bupivacaine, and combination groups were 2.14±0.18, 2.19±0.13, and 2.17±0.11 minutes, respectively (P = 0.103). Mean times of onset (± standard deviation) of motor blockade for the lidocaine, bupivacaine, and combination groups were 3.04±1.81, 4.04±2.68, and 3.38±2.48 minutes, respectively (P = 0.255). Mean time of onset of intraoperative pain for the bupivacaine group, 149.33±46.33 minutes, was prolonged significantly compared with that of the combination group, 115.83±34.49 minutes, and that of the lidocaine group, 94.17±49.86 minutes (P < 0.001). Adequate anesthesia and akinesia (grade 5) were achieved in 56.7% of the patients in the bupivacaine group compared with 23.3% in the lidocaine group and 30% in the combination group (P = 0.049).
  
  
  CONCLUSIONS
  In peribulbar anesthesia, 0.5% bupivacaine solution provides better quality of anesthesia than does combination 2% lidocaine and 0.5% bupivacaine in patients undergoing vitreoretinal surgery.
authors.affiliation: Department of Anesthesiology, Sankara Nethralaya, Vision Research Foundation, Chennai, India.
authors.forename: V V
authors.initials: VV
authors.lastname: Jaichandran
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Raman
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, India.
authors.forename: Laxmi
authors.initials: L
authors.lastname: Gella
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, India. Electronic address: drtaruns@gmail.com.
authors.forename: Tarun
authors.initials: T
authors.lastname: Sharma
mesh_terms: D000698:Analgesia; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D058447:Eye Pain / Q000175:diagnosis; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D057586:Vitreoretinal Surgery
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine