1Reinhardt S., 2Burkhardt U., 1Nestler N., 1Wiedemann R.

1Klinik für Augenheilkunde, Universität Leipzig, Liebigstr. 10-16, 04103 Leipzig; 2Klinik für Anästhesiologie und Intensivtherapie, Universität Leipzig, Liebigstr. 20a, 04103 Leipzig

Objective: To investigate effects of pre-block conscious sedation using piritramid. An attenuation of haemodynamic responses to peribulbar block was expected along with a minimizing effect on patients' pain perception and endocrine stress response.
Methods: In a randomized, single-blinded, placebo-controlled study, 60 patients, mean age 69,9 , having cataract surgery with peribulbar anaesthesia, were randomly allocated to 1 of 2 groups. Group A (n=30) received 0.05 mg/kg piritramid (Dipidolor ®) i.v., group B received normal saline i.v. prior to local anaesthesia. Blood pressure, heart rate, ventilatory frequency and pulse oximetry readings were recorded five times perioperatively. Pain from the anaesthetic block was assessed immediately after the nerve block using a verbal analogue scale. Urinary excretion of vannilylmandelic acid was measured in two 12-h urine samples (night before cataract extraction and day of surgery) of each patient to assess the endocrine stress response.Using a questionnaire, patients' anxiety was rated before performance of peribulbar block and during surgery. In a similar questionnaire, patients rated their back pain during surgery.
Results: Mean arterial pressure remained near baseline values during local anaesthesia and surgery in patients receiving piritramid. In contrast, mean arterial pressure increased significantly after peribulbar block in the placebo group (p < 0.001). In both groups a significantly decreasing heart rate was observed (p < 0.001).There was no significant difference between the two groups in ventilatory frequency and pulse-oximetric oxygen saturation. Piritramid prevented the significant increase in urinary excretion of vanillylmandelic acid found in those patients who received peribulbar block without conscious sedation (p = 0.013). Pain scores (p < 0,001), anxiety before nerve block (p = 0,02) and during surgery (p < 0,001) , and back pain (p = 0,003) were significantly lower in patients receiving intravenous sedation.
Conclusion: The presented study suggests, that conscious sedation with piritramid prior to peribulbar anaesthesia reduces pain perception and stress response and produces a better haemodynamic stability in elderly patients.

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