Comparison of Retrobulbar Block Anesthesia with 0.5 % Levobupivacain and 2% Lidocain in Cataract Surgery

Yıl 2008, Cilt: 10 Sayı: 1, 17 - 21, 01.03.2008

Recep Aksu Abdullah Özkırış Cihangir Biçer Zeynep Tosun Aynur Akın Adem Boyacı

Öz

Aim: To compare the efficacy of retro bulbar block anesthesia with 0.5% levobupivacain and 2% lidocain in cataract surgery. Methods: 30 patients, who need cataract surgery, were included in the study. They were randomized into two groups; 5 ml levobupivacain 0.5 % 5 ml of 2 % lidocain was administered to inferotemporal region for retro bulbar block anesthesia respectively. Sensory and motor block initiation times were recorded. Efficacy of anesthesia were compared according to the intraoperative and postoperative pain perception with 3 point verbal pain scale, patient and surgeon satisfaction was measured with 10 point and akinesia was measured with 13 point scales. Hemodynamic data and side effects were recorded. Results: Demographic variables, duration of surgery and hemodynamic variables were similar in both groups. However, motor and sensory block times were longer and patient and surgeon satisfaction was better in the levobupivacain. Conclusion: Retro bulbar block anesthesia in cataract surgery with 0,5% levobupivacain served longer motor and sensory block times and better patient and surgeon satisfaction compared with 2% lidocain

Anahtar Kelimeler

Levobupivacain, lidocain, retro bulbar anesthesia, cataract

Katarakt Cerrahisinde % 0,5 Levebupivakain Ve % 2 Lidokainin Retrobulbar Blok Anestezisinin Karşılaştırılması

Öz

Amaç:Bu çalışmada, katarakt cerrahisinde retrobulbar anestezi için kullanılan lokal anestezik ajanlardan levobupivakain ile lidokainin etkinliklerinin araştırılması amaçlanmıştır. Yöntemler:Katarakt operasyonu yapılacak 30 olgu çalışmaya alındı. Hastalar 2 gruba ayrıldı. Grup I olgulara 5 ml levobupivakaine % 0.5 ve grup II olgulara ise 5 ml % 2 lidokaine ile retrobulbar anestezi için inferotemporal bölgeden verildi. Sensorial ve motor blok başlama ve bitiş zamanları kaydedildi. İntraoperatif ve postoperatif ağrı verbal ağrı scalası ile anestezi blok etkinliği 3 puanlı, hasta ve cerrah memnuniyeti 10 puanlı ve akinezi 13 puanlı skalada değerlendirildi. Olguların hemodinamik verileri ve görülen yan etkiler kaydedildi. Bulgular:Her iki grubun demografik özellikleri, cerrahi süre ve hemodinamik bulguları benzer iken levobupivakain verilen grupta motor blok ve sensoriyal blok süreleri daha uzun bulundu. Cerrah ve hasta memnuniyetleri ise yine levobupivakain verilen grupta lidokain verilen gruba göre daha iyiydi. Sonuç:Gözün katarakt cerrahisinde retrobulbar yöntemle levobupivakain anestezisi lidokain anestezisine göre daha iyi hasta ve cerrah memnuniyetini ve daha uzun süreli postoperatif dönem anestezisi sağlamaktadır

Anahtar Kelimeler

Levobupivakaine, lidokaine, retrobulbar anestezi, katarakt

Kaynakça

• Hodgkins P, Luff A, Morrell A, et al. Current practice of cataract extraction and anaesthesia. Br J Ophthalmol, 76: 323-326, 1992
• Grover VK, Bhardwaj N, Shobana N, Grewal SP. Oculocardiac reflex during retinal surgery using peribulbar block and nitrous narcotic anesthesia. Ophthalmic Surg Lasers, 29:207-212, 1998
• Fisher SJ, Cunningham RD. The medical profile of cataract patients. Geriatr Clin Nort Am, 1: 339-344, 1985
• Kirkby G, Benson M, Callear A, et al. Local anaesthesia for vitroretinal surgery: a case control study of 200 cases. Eye, 13: 122, 1999
• Davis DB 2nd, Mandel M. Posterior peribulbar anesthesia, an alternative to retrobulbar anesthesia. J Cataract Refract Surg, 12: 182-184, 1986
• Foster RH, Markham A. Levobupivakaine: a review of its pharmacology and use as a local anesthetic. Drugs, 59: 551-579, 2000
• Huang YF, Pryor ME, Mather LE et al. Cardiovascular and central nervous system effects of intravenous Levobupivakaine and bupivacaine in sheep. Anesth Analg, 86: 797-804, 1998
• McLure HA, Kumar CM, Ahmed S, Patel A. A comparison of Lidokaine 2% with Levobupivakaine 0.75% for sub-Tenon’s block. Eur J Anaesthesiology, 22: 500-503, 2005
• Lai F, Sutton B, Nicholson G. Comparison of L-bupivacaine 0.75% and Lidokaine 2% with bupivacaine 0.75% and Lidokaine 2% for peribulbar anaesthesia. Br J Anaesth, 90: 512-514, 2003
• Newsom RSB, Wainwright AC, Canning CR. Local anaesthesia for 1221 vitreoretinal procedures. Br J Ophthalmol, 85: 225-227, 2001
• Pooley GH. An improvement in local anaesthesia in operation upon the eye. The Ophthalmoscope, 12: 464-467, 1914
• SteadSW, Beatie DB, Keyes MA. Anesthesia for ophthalmik surgery. In: Longnecker DE, Tinker JM, Morgan GE, Jr, eds. Principles and practice of anesthesiology. St Louis: Mosby, 2181- 2199, 1998
• Weiss JL, Deichman CB. A comparison of retrobulbar and periocular anesthesia for cataract surgery. Arch Ophthalmol, 107: 96-98, 1989
• Demediuk OM, Ranjit SD, Papwort DP, et al. A comparison of retrobulbar and periocular anesthasia for vitreoretinal surgical procedures. Arch Ophthalmol, 113: 908-913, 1995
• Athanikar NS, Agrawal VB. One point low volume peribulbar anaesthesia versus retrobulbar anaesthasia. A prospective clinical trial. Online India Ophtalmological Society 39: 48-49, 1991
• Sarvela PJ, Paloheima MPJ, Nikki PH. Comparison of pH-Adjusted Bupivacaine 0.75% and a Mixture of Bupivacaine 0.75% and Lidokaine 2%, Both with Hyalurinidase, in Day- Case Cataract surgery Under Regional Anesthesia. Anesth Analg, 79: 35-39, 1994
• Seow LT, Lips FJ, Cousins MJ, Mather LE. Lidokaine and bupivacaine mixtures for epidural blockade. Anesthesiology, 56: 177-183, 1982
• Kallio H, Paloheimo M, Maunuksela EL. Hyalurinidase as an Adjuvant in Bupivacaine- Lidokaine Mixture for Retrobulbar/Peribulbar Block. Anesth Analg, 91: 934-937, 2000
• McLure HA, Rubin AP. Comparison of 0.75% Levobupivakaine with 0.75% racemic bupivacaine for peribulbar anaesthesia. Anaesthesia, 53: 1160-1164, 1998
• Di Donato A, Fontana C, Lancia F, Celleno D. Efficacy and comparison of 0.5% Levobupivakaine with 0.75% ropivacaine for peribulbar anaesthesia in cataract surgery EJA, 23: 487-490, 2006
• Özdemir M, Özdemir G, Zencirci B, Oksuz H. Articaine versus Lidokaine plus bupivacaine for peribulbar anaesthesia in cataract surgery. Br J Anaesth 92: 231-234, 2004