Recep AKSU, Abdullah ÖZKIRIŞ, Cihangir BİÇER, Zeynep TOSUN, Aynur AKIN, Adem BOYACI

Katarakt Cerrahisinde % 0,5 Levebupivakain Ve % 2 Lidokainin Retrobulbar Blok Anestezisinin Karşılaştırılması

Amaç:Bu çalışmada, katarakt cerrahisinde retrobulbar anestezi için kullanılan lokal anestezik ajanlardan levobupivakain ile lidokainin etkinliklerinin araştırılması amaçlanmıştır. Yöntemler:Katarakt operasyonu yapılacak 30 olgu çalışmaya alındı. Hastalar 2 gruba ayrıldı. Grup I olgulara 5 ml levobupivakaine % 0.5 ve grup II olgulara ise 5 ml % 2 lidokaine ile retrobulbar anestezi için inferotemporal bölgeden verildi. Sensorial ve motor blok başlama ve bitiş zamanları kaydedildi. İntraoperatif ve postoperatif ağrı verbal ağrı scalası ile anestezi blok etkinliği 3 puanlı, hasta ve cerrah memnuniyeti 10 puanlı ve akinezi 13 puanlı skalada değerlendirildi. Olguların hemodinamik verileri ve görülen yan etkiler kaydedildi. Bulgular:Her iki grubun demografik özellikleri, cerrahi süre ve hemodinamik bulguları benzer iken levobupivakain verilen grupta motor blok ve sensoriyal blok süreleri daha uzun bulundu. Cerrah ve hasta memnuniyetleri ise yine levobupivakain verilen grupta lidokain verilen gruba göre daha iyiydi. Sonuç:Gözün katarakt cerrahisinde retrobulbar yöntemle levobupivakain anestezisi lidokain anestezisine göre daha iyi hasta ve cerrah memnuniyetini ve daha uzun süreli postoperatif dönem anestezisi sağlamaktadır

Anahtar Kelimeler:

Levobupivakaine, lidokaine, retrobulbar anestezi, katarakt

Comparison of Retrobulbar Block Anesthesia with 0.5 % Levobupivacain and 2% Lidocain in Cataract Surgery

Aim: To compare the efficacy of retro bulbar block anesthesia with 0.5% levobupivacain and 2% lidocain in cataract surgery. Methods: 30 patients, who need cataract surgery, were included in the study. They were randomized into two groups; 5 ml levobupivacain 0.5 % 5 ml of 2 % lidocain was administered to inferotemporal region for retro bulbar block anesthesia respectively. Sensory and motor block initiation times were recorded. Efficacy of anesthesia were compared according to the intraoperative and postoperative pain perception with 3 point verbal pain scale, patient and surgeon satisfaction was measured with 10 point and akinesia was measured with 13 point scales. Hemodynamic data and side effects were recorded. Results: Demographic variables, duration of surgery and hemodynamic variables were similar in both groups. However, motor and sensory block times were longer and patient and surgeon satisfaction was better in the levobupivacain. Conclusion: Retro bulbar block anesthesia in cataract surgery with 0,5% levobupivacain served longer motor and sensory block times and better patient and surgeon satisfaction compared with 2% lidocain

Keywords:

Levobupivacain, lidocain, retro bulbar anesthesia, cataract,

PDF

___

Hodgkins P, Luff A, Morrell A, et al. Current practice of cataract extraction and anaesthesia. Br J Ophthalmol, 76: 323-326, 1992
Grover VK, Bhardwaj N, Shobana N, Grewal SP. Oculocardiac reflex during retinal surgery using peribulbar block and nitrous narcotic anesthesia. Ophthalmic Surg Lasers, 29:207-212, 1998
Fisher SJ, Cunningham RD. The medical profile of cataract patients. Geriatr Clin Nort Am, 1: 339-344, 1985
Kirkby G, Benson M, Callear A, et al. Local anaesthesia for vitroretinal surgery: a case control study of 200 cases. Eye, 13: 122, 1999
Davis DB 2nd, Mandel M. Posterior peribulbar anesthesia, an alternative to retrobulbar anesthesia. J Cataract Refract Surg, 12: 182-184, 1986
Foster RH, Markham A. Levobupivakaine: a review of its pharmacology and use as a local anesthetic. Drugs, 59: 551-579, 2000
Huang YF, Pryor ME, Mather LE et al. Cardiovascular and central nervous system effects of intravenous Levobupivakaine and bupivacaine in sheep. Anesth Analg, 86: 797-804, 1998
McLure HA, Kumar CM, Ahmed S, Patel A. A comparison of Lidokaine 2% with Levobupivakaine 0.75% for sub-Tenon’s block. Eur J Anaesthesiology, 22: 500-503, 2005
Lai F, Sutton B, Nicholson G. Comparison of L-bupivacaine 0.75% and Lidokaine 2% with bupivacaine 0.75% and Lidokaine 2% for peribulbar anaesthesia. Br J Anaesth, 90: 512-514, 2003
Newsom RSB, Wainwright AC, Canning CR. Local anaesthesia for 1221 vitreoretinal procedures. Br J Ophthalmol, 85: 225-227, 2001
Pooley GH. An improvement in local anaesthesia in operation upon the eye. The Ophthalmoscope, 12: 464-467, 1914
SteadSW, Beatie DB, Keyes MA. Anesthesia for ophthalmik surgery. In: Longnecker DE, Tinker JM, Morgan GE, Jr, eds. Principles and practice of anesthesiology. St Louis: Mosby, 2181- 2199, 1998
Weiss JL, Deichman CB. A comparison of retrobulbar and periocular anesthesia for cataract surgery. Arch Ophthalmol, 107: 96-98, 1989
Demediuk OM, Ranjit SD, Papwort DP, et al. A comparison of retrobulbar and periocular anesthasia for vitreoretinal surgical procedures. Arch Ophthalmol, 113: 908-913, 1995
Athanikar NS, Agrawal VB. One point low volume peribulbar anaesthesia versus retrobulbar anaesthasia. A prospective clinical trial. Online India Ophtalmological Society 39: 48-49, 1991
Sarvela PJ, Paloheima MPJ, Nikki PH. Comparison of pH-Adjusted Bupivacaine 0.75% and a Mixture of Bupivacaine 0.75% and Lidokaine 2%, Both with Hyalurinidase, in Day- Case Cataract surgery Under Regional Anesthesia. Anesth Analg, 79: 35-39, 1994
Seow LT, Lips FJ, Cousins MJ, Mather LE. Lidokaine and bupivacaine mixtures for epidural blockade. Anesthesiology, 56: 177-183, 1982
Kallio H, Paloheimo M, Maunuksela EL. Hyalurinidase as an Adjuvant in Bupivacaine- Lidokaine Mixture for Retrobulbar/Peribulbar Block. Anesth Analg, 91: 934-937, 2000
McLure HA, Rubin AP. Comparison of 0.75% Levobupivakaine with 0.75% racemic bupivacaine for peribulbar anaesthesia. Anaesthesia, 53: 1160-1164, 1998
Di Donato A, Fontana C, Lancia F, Celleno D. Efficacy and comparison of 0.5% Levobupivakaine with 0.75% ropivacaine for peribulbar anaesthesia in cataract surgery EJA, 23: 487-490, 2006
Özdemir M, Özdemir G, Zencirci B, Oksuz H. Articaine versus Lidokaine plus bupivacaine for peribulbar anaesthesia in cataract surgery. Br J Anaesth 92: 231-234, 2004