Effects of peribulbar bupivacaine as an adjunct to general anaesthesia on peri-operative outcome following retinal detachment surgery

Sixty premedicated, ASA physical status I or II patients weighing > 25 kg s cheduled for elective retinal detachment repair were randomly assigned to r eceive either peribulbar block with 10 ml of 0.25% bupivacaine (block group ) or intravenous morphine 150 mug.kg(-1) (morphine group), prior to the ind uction of general anaesthesia (n = 30 in each group). Patients were evaluat ed for intraoperative oculocardiac reflex, peri-operative pain relief, reco very from anaesthesia and postoperative nausea and vomiting. Apart from sig nificantly reducing the incidence of oculocardiac reflex (30% vs. 70%, p = 0.0019), peribulbar bupivacaine also attenuated the severity of the reflex. Postoperative pain relief was superior in the block group. More block grou p patients had the maximum recovery score in the immediate postoperative pe riod (80% vs. 27%, p < 0.0001) and they achieved complete recovery signific antly faster than the morphine group (17.3 (14.7) min vs. 66.7 (29.7) min, p < 0.0001). The incidence (40% vs. 77%, p = 0.004) and severity of postope rative nausea and vomiting were significantly less in the block group. In s ummary peribulbar bupivacaine, when administered together with general anae sthesia, attenuated oculocardiac reflex, provided comparable intra-operativ e and superior postoperative analgesia, resulted in significantly earlier a nd better recovery from anaesthesia, and significantly reduced the incidenc e and severity of postoperative nausea and vomiting.