1Jäger M., 2Hemmerling T., 1Jonas J. B.

1Augenklinik, Fakultät für klinische Medizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, 2Department of Anesthesiology, Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montréal, Canada

Purpose: The prospective randomised double masked study compared three local anesthetics of different onset and duration of action to determine the best anesthetic for pain control during and after intraocular surgery with an indwelling retrobulbar catheter.
Methods: Since December 2000, 54 patients undergoing ocular surgery such as pars plana vitrecomy (n=34), scleral buckling procedures (n=11) or kryocoagulation (n=9) have been randomised to receive either 8ml bupivacaine 0.5%, ropivacaine 0.75% or mepivacaine 2% (each n= 18) through an retrobulbar needle (diameter 0.8mm, lenghth 38mm) before surgery. Additionally, an indwelling catheter was introduced through the same needle into the retrobulbar space. When the patients started to feel pain intra- or postoperatively 2ml of the same anesthetic were injected through the inserted retrobulbar catheter.
Results: The mean duration of surgery was 67.78±45.56 minutes. The mean amount of re-injected anesthetic (9.11±1.77ml) and the frequency of re-injections (1,56±0,86) during surgery was lowest in the ropivacaine group without being statistically significant between the three groups. The mean time of the first reinjection was significantly shorter after mepivacaine injection (28,33±17,14 minutes) than bupivacaine or ropivacaine. Additional subconjuntival injections were performed in one patient of the ropivacaine group, and in 6 patients of the bupivacaine-group. Six patients of the bupivacaine-group received systemic analgetics and 3 patients of the mepivacaine group. Intraoperatively, the ropivacaine group had the lowest pain score. Postoperatively, the patients of the bupivacaine-group showed a reduced need for reinjections (0.56±0.92) and anesthetic volume (1.11±1.84ml), they demanded re-injections later (270±162.56 minutes) than the patients of the two other study groups. The patients of the bupivacaine group had the lowest pain score after surgery: Five patients with bupivacaine needed additional systemic analgesics compared to 15 patients with mepivacaine. The bupivacaine anesthesia provided a longer ocular akinesia.
Conclusion: Combination of a short-acting local anesthetics such as mepivacain during surgery with a long-acting local anesthetics for postoperative re-injections may be useful for anethesia using an indwelling retrobulbar catheter in intraocular surgery.

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