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Impressum
The new local anesthetic Ropivacain for scleral buckling surgery
Schönfeld C.-L., Buhl M., Böttger T.
Augenklinik der Ludwig Maximilians-Universität, München
Objective: The new local anesthetic Ropivacain was compared with
the established local anesthetic Bupivacain. Ropivacain is advantageous
because of less neurologic and cardiologic toxicities and its longer anesthetic
effect.
Patients and Methods: 100 patients with rhegmatogenous retinal
detachments were enrolled in this prospective study. The assignment to
the local anesthetic was blind. 7 ccm of the local anesthetic were injected
retrobulbar. Intraoperative and postoperative parameters were examined:
begin of anesthesia, time interval between injection and begin of surgery,
time of surgery, sensibility and motility of the eye, paresthesia, patient´s
subjective perception of pain using the Visual Analogue Scale (VAS) and
surgeon´s opinion about quality of anesthesia.
Results: The begin of anesthesia was similar for both local anesthetics.
Ropivacain was more effective than Bupivacain: in the Bupivacain group
14 patients received additional injections of local anesthetic, whereas
in the Ropivacain group 8 patients did (p<0.05). Therefore, the median
of intraoperative pain (VAS) in the Bupivacain group (13; 62) was higher
than in the Ropivacain group (0; 44) (median of VAS; 90%-percentile).
Paresthesia was observed more frequently under Ropivacain anesthesia immediately
after surgery. Intraoperative and postoperative anesthesia were more effective
in eyes, which were operated before under Ropivacain than under Bupivacain
(p< 0.01). Surgeon´s satisfaction with intraoperative anesthesia
was the same for both local anesthetics.
Conclusion: Ropivacain provides better intraoperative and postoperative
anesthesia than Bupivacain. Ropivacain is advantageous especially in eyes
which were operated before. Ropivacain, retrobulbar injected, is appropriate
for scleral buckling prodecures for rhegmatogenous retinal detachment.