Purpose:

To compare efficacy of levobupivacaine 0.5%, ropivacaine 0.5% and 0.25% levobupivacaine plus 0.25% ropivacaine for peribulbar block in patients undergoing cataract surgery.

Patients and Methods:

Double-blinded clinical trial on 90 patients undergoing phacoemulsification equally and randomly divided into three groups; Group I received peribulbar anesthesia (PBA) using levobupivacaine 0.5%, Group II received PBA using ropivacaine 0.5% and Group III received PBA using combination of half of volume used for both other groups. Akinesia was assessed using ocular and eye lid movement scores, while a verbal pain score (VPS) used to assess pain.

Results:

VPS for injection pain showed non-significant (p=0.763) difference between the three groups. 82 patients (91.1%) felt no pain (score=0). 5 patients (8.9%); 3 from group II and 2 from group III felt mild discomfort (score= 1-2) with non-significant (p=0.542) difference, despite of being in favor of group III. Ocular movement scores showed no significant differences between study groups. Duration of anesthesia was non-significantly (p=0.693) shorter in group I compared to group II. While it was significantly (p=0.015) shorter in group I compared to group III and significantly (p=0.0055) shorter in group II compared to group III.

Conclusion:

Ropivacaine 0.5% is as effective as levobupivacaine 0.5% in terms of pain scores, akinesia and duration of anesthesia. Combination of 0.25% of both types

add the benefit of low systemic complication profile of ropivacaine to the rapid onset of levobupivacaine.