The Effectiveness And Safety Of Different Local Anesthetics In Peribulbar Anesthesia Of Vitrectomy

PURPOSETo compare the intraoperative and postoperative clinical properties of 1% ropivacaine,0.75% bupivacaine,2% lidocaine,and a mixture of 0.75% bupivacaine and 2% lidocaine(bupi+lido)administered for peribulbar anesthesia during vitrectomy METHODSA total of 140 patients were randomly allocated to four groups.The time of onset of analgesia and akinesia was measured.The efficacy of anesthesia,degree of postoperative pain,and intraoperative and postoperative complications were recorded.RESULTSThe mean times of onset(±standard deviation)of analgesia for the ropivacaine,bupivacaine,lidocaine,and lido+bupi groups were 90.46±30.08,94.83±40.72,78.31±12.56,and 101.51±56.94 seconds,respectively(P = 0.087).The mean times of onset(±standard deviation)of akinesia for the ropivacaine,bupivacaine,lidocaine,and lido+bupi groups were 138.89±62.65,151.86±84.78,122.66±49.35,and 141.54±62.69 seconds,respectively(P = 0.323).No significant difference was observed in the number of patients who attained grade 5 anesthesia in the four groups(P = 0.966).The outcome ofordered logit analysis showed that the 1% ropivacaine resulted in a significantly lower degree of postoperative pain compared with the other three groups(P = 0.017,P = 0.001,P = 0.001;respectively).The incidence of postoperative subconjunctival hemorrhage was decreased in the ropivacaine group compared to the other three groups(P < 0.001).CONCLUSIONSFor peribulbar anesthesia in vitrectomy,1% ropivacaine alone provides an adequate intraoperative anesthesia similar to that provided by the bupivacaine,lidocaine,and lido+bupi solutions,as well as provides a better quality of postoperative analgesia and decreases postoperative subconjunctival hemorrhage.TRIAL REGISTRATION NUMBERChi CTR-IPR-16007876.