Ropivacaine for peribulbar anesthesia

Background and Objectives. We compared the efficacy of a mixture of ropivac aine and lidocaine with a mixture of bupivacaine and lidocaine for providin g peribulbar anesthesia for cataract surgery. We used the time to adequate block for surgery and ocular and eyelid movement scores as clinical end poi nts. 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. Hyaluro nidase 15 IU.mL(-1) was added to both solutions. Results. The median time a t which the block was adequate to start surgery was 8 minutes for each grou p. 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 th e groups in the incidence of minor complications or of pain during insertio n of the block. Seven patients in the ropivacaine group and 12 patients in the bupivacaine group required supplementary anesthesia. Conclusions. Ropiv acaine 1% is an effective alternative to 0.75% bupivacaine for peribulbar a nesthesia, when combined with lidocaine and hyaluronidase.