Comparing 0.5% Bupivacaine versus 0.5% Levobupivacaine for peribulbar anaesthesia in cataract surgery

Vanlalruati  Fanai; Israel  Lalramthara; Vanlalhruaii

doi:10.51168/sjhrafrica.v5i9.1391

Authors

Vanlalruati Fanai Associate Professor, Department of Ophthalmology, Zoram Medical College, Aizawl, Mizoram, India (
Israel Lalramthara Assistant Professor, Department of Anaesthesiology, Zoram Medical College, Aizawl, Mizoram, India
Vanlalhruaii Assistant Professor, Department of Ophthalmology, Zoram Medical College, Aizawl, Mizoram, India

DOI:

https://doi.org/10.51168/sjhrafrica.v5i9.1391

Keywords:

levobupivacaine, bupivacaine, cataract, anaesthesia

Abstract

Background: The choice of drug used in the anaesthesia affects the overall outcome of cataract surgery, regarding patient satisfaction and adverse effects.

Objectives: This study aimed to compare the efficacy and tolerability of levobupivacaine and bupivacaine in anaesthesia for cataract surgery.

Materials and Methods: This was a double-blinded randomized study conducted in the operation theatre of Zoram Medical College for a year. The patients who were to undergo cataract surgery were considered for this study. They were divided randomly and were evaluated for the efficacy and safety of the drugs under study. The data obtained was compared statistically.

Results: The akinesia score of the bupivacaine group at 10 minutes was 0.24±0.14 and for the levobupivacaine group it was 0.25±0.34. The patient’s satisfaction score in the bupivacaine group was 8.2±0.34 and in the levobupivacaine group, it was 8.4±0.21. The surgeons rated the quality of the motor block, the bupivacaine group had an average of 7.23±0.42 and for levobupivacaine, the average was 7.88±0.32. The results of both groups are comparable.

Conclusion: The motor and sensory blockade for cataract surgery can be achieved with bupivacaine and levobupivacaine with similar efficacy and tolerance.z

Recommendation: Levobupivacaine should be used as a local anaesthetic in patients with systemic disease to improve the outcome of the surgery.

References

Lam, D., Rao, S. K., Ratra, V., Liu, Y., Mitchell, P., King, J., ... & Chang, D. F. (2015). Cataract. Nature reviews Disease primers, 1(1), 1-15. https://doi.org/10.1038/nrdp.2015.14 PMid:27188414

Asbell, P. A., Dualan, I., Mindel, J., Brocks, D., Ahmad, M., & Epstein, S. (2005). Age-related cataract. The Lancet, 365(9459), 599-609. https://doi.org/10.1016/S0140-6736(05)70803-5

Patel BC, Burns TA, Crandall A, et al. A comparison of topical and retrobulbar anesthesia for cataract surgery. Ophthalmology. 1996;103: 1196-1203. https://doi.org/10.1016/S0161-6420(96)30522-8 PMid:8764787

Davis DB II, Mandel MR. Efficacy and complication rate of 16,224 consecutive peribulbar blocks: a prospective multicenter study. J Cataract Refract Surg. 1994;20:327-337. https://doi.org/10.1016/S0886-3350(13)80586-X PMid:8064611

Dempsey GA, Barrett PJ, Kirby IJ. Hyaluronidase and peribulbar block. Br J Anaesth. 1997;78:671-674. https://doi.org/10.1093/bja/78.6.671 PMid:9215017

Aberg G. Toxicological and anesthetic effects of optically active isomers of two anesthetic compounds. Acta Pharmacol Toxicol. 1972;31: 273-286. https://doi.org/10.1111/j.1600-0773.1972.tb00683.x

Lee-Son S, Wang GK, Concus A, Crill E, Strichartz G. Stereoselective inhibition of neuronal sodium channels by local anesthetics. Evidence of two sites of action? Anesthesiology. 1992;77:324-335. https://doi.org/10.1097/00000542-199208000-00016 PMid:1322642

Dyhre H, Lång M, Wallin R, Renck H. The duration of action of bupivacaine, levobupivacaine, ropivacaine, and pethidine in peripheral nerve block in the rat. Acta Anaesthesiol Scand. 1997;41:1346-1352. https://doi.org/10.1111/j.1399-6576.1997.tb04656.x PMid:9422304

Kanai Y, Tateyama S, Nakamura T, Kasaba T, Takasaki M. Effects of levobupivacaine, bupivacaine, and ropivacaine on tail-flick response and motor function in rats following epidural or intrathecal administration. Reg Anesth Pain Med. 1999;24:444-452. https://doi.org/10.1016/S1098-7339(99)90012-3 PMid:10499757

Gristwood RW, Greaves JL. Levobupivacaine: a new safer long acting local anesthetic agent. Expert Opin Investig Drugs. 1999;8: 861-876. https://doi.org/10.1517/13543784.8.6.861 PMid:15992136

Morrison SG, Dominguez JJ, Frascarolo P, et al. Cardiotoxic effects of levobupivacaine, bupivacaine, and ropivacaine - an experimental study in pentobarbital anesthetized swine. Reg Anesth Pain Med. 1998;23 Suppl 3:50. https://doi.org/10.1097/00115550-199823031-00050

Kopacz DJ, Allen HW, Thompson GE. A comparison of epidural levobupivacaine 0.75% with racemic bupivacaine for lower abdominal surgery. Anesth Analg. 2000;90:642-648. https://doi.org/10.1097/00000539-200003000-00026 PMid:10702451

McLure HA, Rubin AP. Comparison of 0.75% levobupivacaine with racemic bupivacaine for peribulbar anesthesia. Anesthesia. 1988;53: 1160-1164. https://doi.org/10.1046/j.1365-2044.1998.00632.x PMid:10193217

Bedi A, Carabine U. Peribulbar anesthesia: a double-blind comparison of three local anesthetic solutions. Anesthesia. 1999;54:67-71. https://doi.org/10.1046/j.1365-2044.1999.00639.x PMid:10209373

Mehmet B, Aylin K, Sibel O, Cengiz A, Yonca AA. Comparison of a bupivacaine 0.5% and lidocaine 2% mixture with levobupivacaine 0.75% and ropivacaine 1% in peribulbar anesthesia for cataract surgery with phacoemulsification. Acta Ophthalmol Scand. 2007;85:844-847. https://doi.org/10.1111/j.1600-0420.2007.00976.x PMid:17662095

Ahmad N, Zahoor A, Al Assiri A, Al Jastaneiah S, Riad W. Comparison of levobupivacaine 0.5% or bupivacaine 0.5% both in a mixture with lidocaine 2% for superficial extraconal blockade. Middle East Afr J Ophthalmol. 2012;19:330-333. https://doi.org/10.4103/0974-9233.97945 PMid:22837629 PMCid:PMC3401805

Birt DJ, Cummings GC. The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anesthesia. Eye (Lond). 2003;17:200-206. https://doi.org/10.1038/sj.eye.6700313 PMid:12640407