Abstract
Fifty patients scheduled for cataract surgery under peribulbar block were randomised to receive either plain (pH 5.4) or pH-adjusted (pH 6.8 range 6.7–6.9) 0.75% bupivacaine. Hyaluronidase was added to both solutions prior to peribulbar block. The time of onset of akinesia of the globe and the need for supplementary injections were recorded by an independent observer. Patients who returned for surgery to the second eye received the alternative local anaesthetic solution for the second peribulbar block. The relative efficacy of the different anaesthetic solutions was compared in patients who underwent unilateral surgery (Group A, n = 50). In 12 patients (Group B) who underwent bilateral surgery, direct comparisons between eyes in the same patient were possible. In both groups of patients, eyes receiving peribulbar block with the pH-adjusted solution showed a shorter time to partial akinesia of the globe (P < 0.05). However, there was no difference between the solutions in the time to complete akinesia of the globe, but the number of supplementary injections required for an effective block with the pH-adjusted solution was increased. Onset time to akinesia of the lateral and superior rectus muscles was shortened in patients receiving the pH-adjusted solution but there were minimal effects on the medial and inferior recti.
Résumé
Cinquante patients devant subir une extraction de cataracte sous anesthésie régionale rétrobulbaire participent à cette étude. Le choix de l’agent anesthésique utilisé se fait au hasard et comporte la bupivacaine 0,75% avec pH á 5,4 (formule commerciale) ou bupivacaïne 0,75% avec pH corrigé à 6,8 (valeurs variant entre 6,7 et 6,9). Quand un patient revient pour une chirurgie de l’autre oeil, le choix de l’anethésique local est alterné. Dans tous les cas, de l’hyaluronidase est ajoutée à l’anesthésique local. Un observateur non informé de l’agent utilisé note le temps nécessaire pour obtenir une akinésie de l’oeil, ainsique le besoin d’injections supplémentaires. L’efficacité des deux solutions anesthésiques est comparée entre les patients soumis à une seule chirurgie (Groupe A, n = 50). Chez 12 patients subissant deux interventions (Groupe B), des comparaisons entre les yeux du même patient sont faites. Dans les deux groupes de comparaisons, la solution avec pH corrigé permet un début plus rapide d’akinésie partielle du globe oculaire (P < 0,05). Cependant, le temps nécessaire pour obtenir une akinésie complète est comparable avec une solution ou l’autre. L’utilisation de la solution à pH corrigé entraîne un plus grand nombre d’injections suppleméntaires. Elle permet un début plus rapide d’akinesie des muscles droits supérieur et latéral, mais a peu d’effets sur les muscles droits interne et inférieur.
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Lewis, P., Hamilton, R.C., Brant, R. et al. Comparison of plain with pH-adjusted bupivacaine with hyaluronidase for peribulbar block. Can J Anaesth 39, 555–558 (1992). https://doi.org/10.1007/BF03008317
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DOI: https://doi.org/10.1007/BF03008317