Ropivacaine-lidocaine versus bupivacaine-lidocaine for retrobulbar anesthesia in cataract surgery

PURPOSE: To compare the efficacy of ropivacaine mixed with lidocaine and bupivacaine mixed with lidocaine for retrobulbar anesthesia in cataract surgery. SETTING: Philippine General Hospital, Manila, Philippines. METHODS: This prospective double-masked study consisted of 80 patients randomized to receive ropivacaine 1%-lidocaine 2% (Group 1) or bupivacaine 0.5%-lidocaine 2% (Group 2) for retrobulbar anesthesia during extracapsular cataract extraction (ECCE). The main outcome measures were frequency of eye pain and amount of globe movement. The degree of pain was scored from 0 to 10 using a visual analog scale. Globe movement in 4 directions of gaze was measured with a ruler. RESULTS: The number of patients with visual analog system scores greater than zero at 5 minutes after infiltration, 10 minutes after infiltration, intraoperatively, and 1, 2, and 4 hours postoperatively was 0, 0, 0, 1, 18, and 29, respectively, in Group 1 and 1, 1, 0, 1, 21, and 33, respectively, in Group 2. The mean globe movement at 5 minutes, 10 minutes after infiltration, and intraoperatively was 5.1 mm, 3.0 mm, and 0.6 mm, respectively, in Group 1 and 4.9 mm, 3.0 mm, and 0.3 mm, respectively, in Group 2. There were no significant differences in frequency of pain and amount of globe movement between the 2 groups at any time. No adverse reactions developed in either group. The duration of surgery was similar between groups. CONCLUSION: Ropivacaine mixed with lidocaine and bupivacaine mixed with lidocaine were equally effective in producing ocular analgesia and akinesia for ECCE.