Retrobulbar/peribulbar block with 0.2% ropivacaine or 1% lidocaine for transscleral cyclophotocoagulation or retinal...

Brief analgesia is needed to complete krypton laser cyclophotocoagulation for glaucoma patients and is advantageous in argon laser panphotocoagulation for diabetic retinopathy. We studied whether 0.2% ropivacaine, known for analgesia with minimal motor block or 1% lidocaine, with rapid onset and short duration of action, both supplemented with hyaluronidase, are suitable local anesthetics for retrobulbar/peribulbar block for these procedures.

Seventy-four treatment sessions of 65 patients were included in this prospective, randomized, double-blind study. Data were collected on adequacy of analgesia, need for supplementary blocks and eye movements at 10 minutes after injecting the block and at the end of the treatment, and need for patching the eye at discharge.

Frequency of inadequate analgesia (24% in ropivacaine group and 32% in lidocaine group), and of supplementary blocks (11% and 14%, respectively) did not differ between the groups and exceeded our clinically acceptable level. Ropivacaine produced less motor block than lidocaine at 10 minutes (P < .001) and at the end of the treatment (P = .002). However, at discharge, the eye was significantly more often patched in the ropivacaine (70%) group than in the lidocaine group (41 %) (P = .035). In the ropivacaine group, a mobile eye did not predict inadequate intraoperative analgesia, whereas in the lidocaine group it did (P = .001).

According to our preliminary data, neither 0.2% ropivacaine nor 1% lidocaine reached acceptable frequencies of adequate analgesia during transscleral cyclophotocoagulation, while all retinal panphotocoagulations could be completed under the initial block.