Ropivacaine for peribulbar anesthesia

Background and Objectives. We compared the efficacy of a mixture of ropivacaine and lidocaine with a mixture of bupivacaine and lidocaine for providing peribulbar anesthesia for cataract surgery. We used the time to adequate block for surgery and ocular and eyelid movement scores as clinical end points. Methods. Ninety patients were allocated randomly to receive 7-10 mL of an anesthetic mixture of equal parts 0.75% bupivacaine and 2% lidocaine or a mixture in which ropivacaine 1% was substituted for bupivacaine. Hyaluronidase 15 IU.mL(-1) was added to both solutions. Results. The median time at which the block was adequate to start surgery was 8 minutes for each group. Median ocular movement scopes were similar in both groups at all times. Ropivacaine produced decreased eyelid movement scores at 2 (P = .047), 6 (P = .038), and 8 minutes (P = .016). No differences were observed between the groups in the incidence of minor complications or of pain during insertion of the block. Seven patients in the ropivacaine group and 12 patients in the bupivacaine group required supplementary anesthesia. Conclusions. Ropivacaine 1% is an effective alternative to 0.75% bupivacaine for peribulbar anesthesia, when combined with lidocaine and hyaluronidase.