A Comparative Study of 2% Lidocaine Plus 0.5% Ropivacaine Versus 2% Lidocaine Plus 0.5% Bupivacaine for Peribulbar Anesthesia in Cataract Surgeries

Introduction: The goals of safe and effective anesthesia for intraocular surgery is to obtain good analgesia and anesthesia without complications. Peribulbar anesthesia has been the anesthesia of choice for cataract surgery and is routinely performed with a mixture of local anesthetics, most common combination being bupivacaine and lidocaine. The aminoamide, Ropivacaine, a derivative of mepivacaine, was introduced in 1996 as the safer alternative to bupivacaine. Hence, we compared the efficacy and complications of ropivacaine and bupivacaine, both in combination with lidocaine and hyaluronidase for peribulbar anesthesia by two-point injection technique for cataract surgery. Materials and Methods: In this study, 60 consenting patients posted for cataract surgery under peribulbar anesthesia with two-point injection technique were included. They were randomly categorized into two groups of 30 patients each. One group received ropivacaine with lidocaine plus hyaluronidase and the other group received bupivacaine with lidocaine plus hyaluronidase. The efficacy was compared in terms of akinesia and analgesia achieved by each of these agents both intraoperatively and postoperatively. Results were analyzed using paired t test, ANOVA, and chi-square test. Results: Based on our observations regarding onset of action, duration of anesthesia, early recovery of motor blockade and intraocular pressure changes, ropivacaine scored better than bupivacaine. There were no differences in effects on mean arterial pressure and ECG rhythm changes and even though bupivacaine decreased heart rate from baseline value, bradycardia did not occur in both groups. Conclusion: Ropivacaine is a better agent than bupivacaine for peribulbar anesthesia due to its faster onset and shorter duration with less effects on intraocular pressure. However, cardiovascular toxicity does not occur with either ropivacaine or bupivacaine when used in peribulbar anesthesia for cataract surgery.