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Year : 2018  |  Volume : 32  |  Issue : 3  |  Page : 190-194

Comparison of lignocaine 2% with adrenaline and a mixture of bupivacaine 0.5% plus lignocaine 2% with hyaluronidase for peribulbar block analgesia

Department of Ophthalmology, J.N. Institute of Medical Sciences, Imphal, Manipur, India

Correspondence Address:
Dr. Ngangom Sangeeta Devi
Thangmeiband Lairenhanjaba Leikai, Imphal West - 795 004, Manipur
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jms.jms_63_18

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Purpose: Lignocaine and bupivacaine are the most freely available local anesthetic agents which may be used alone or in combination for peribulbar block analgesia (PBA) with or without hyaluronidase and epinephrine. A prospective comparative study of two solutions was undertaken to rationalize choice of local analgesic agent for PBA. Materials and Methods: A randomized, prospective study on 100 middle-aged to elderly patients undergoing cataract extraction was undertaken to compare the efficacy of (1) 2% lidocaine plus epinephrine 1:200,000 (Group 1) or (2) a mixture of 2% lidocaine and 0.5% bupivacaine (2:3 volume per volume mix) (Group 2). A standardized deep peribulbar block technique, akinesia scoring system, analgesia scoring system, and supplemental protocol were followed. The onset of block and supplementation rates to achieve akinesia was recorded by a blinded observer. The time from 1st PBA injection to the completion of surgery (the duration of surgical access) was also recorded. Results: Significantly better results for akinesia were obtained with the combination of 2% lignocaine plus 0.5% bupivacaine mixed with 50 IU/ml of hyaluronidase at 10 min after injection and also at the end of surgery. However, with regard to analgesia, both 2% lignocaine and 2% lignocaine with 0.5% bupivacaine had a similar effect. Furthermore, the patients in Group 2 showed a significantly reduced need for the first supplemental injection and no need for a second supplemental injection. The incidence of complications was very low in this study. No serious local or systemic complication was encountered. Conclusion: The combination of 2% lignocaine with 0.5% bupivacaine results in a better quality peribulbar block than 2% lignocaine alone, while perioperative analgesia was found to be similar for both combinations. The former also required less frequent supplementary injections.

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