Randomized double-blind study of the clinical duration and efficacy of Nesacaine-MPF 2% and 3% in peribulbar anesthesia

Local anesthesia for cataract surgery

Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.

A controlled clinical interventional trial comparing 2% chloroprocaine-bupivicaine versus 2% lidocaine-bupivicaine for retrobulbar anesthesia in scleral buckling surgery

OBJECTIVE

We undertook this prospective study to compare the relative effectiveness of a bupivicaine mixture with either lidocaine or chloroprocaine for retrobulbar anesthesia in scleral buckling surgery, since chloroprocaine, in some types of nonocular nerve block anesthesia, has been demonstrated to be a more effective nerve block anesthetic.

DESIGN

This prospective, randomized, double-blind, controlled, clinical, unicentre, interventional trial compared mixtures of lidocaine-bupivacaine with chloroprocaine-bupivacaine in scleral buckling surgery performed by 1 surgeon during a 12-month period.

PARTICIPANTS

A total of 136 patients who underwent scleral buckling surgery constituted the cases studied.

METHODS

A total of 31 variables comprising surgical, anesthetic, and patient-centered data were analyzed to determine which drug combination was more efficacious.

RESULTS

No statistically significant differences were found between chloroprocaine and lidocaine mixtures for retrobulbar anesthesia in scleral buckling surgery from the point of view of the surgeon, anesthetist, or patient.

CONCLUSIONS

We found no difference in effectiveness for bupivicaine mixed with either lidocaine or chloroprocaine for retrobulbar anesthesia in scleral buckling surgery. Surgeon, anesthetist, and patient-centered data showed no differences in any of the measures studied.

Short-acting peribulbar anesthesia with 2-chloroprocaine

A 64-year-old monocular man had uneventful penetrating keratoplasty in his seeing eye for aphakic bullous keratopathy and counting fingers visual acuity. One year later, standard slitlamp suture removal under topical anesthesia was not possible because of sensory nystagmus. In addition, the patient could not have general anesthesia as a consequence of severe coronary artery disease. He requested that the procedure be done with a short-acting local anesthetic agent so a patch would not be necessary. He successfully had the procedure using a peribulbar injection of 2-chloroprocaine (Nesacaine-MPF); vision and ocular motility returned 15 minutes after the surgery was completed. At subsequent examinations, the visual acuity was 20/200 and the graft was clear despite a congenital macular scar.