Levobupivacaine vs. racemic bupivacaine in peribulbar anaesthesia: a randomized double blind study in ophthalmic surgery

E. Pacella, S. Collini*, F. Pacella, D.C. Piraino, V. Santamaria, R.A. De Blasi*

Ophthalmological Science Department, University of Rome “Sapienza”, Rome (Italy) *Department of Anestesiology, University of Rome 2nd “Sapienza” S. Andrea, Rome (Italy)

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• Anesthesiology

Abstract. Aims: The Authors examine the employement of a new anaesthetic agent, levobupivacaine 0.50% (S – enantiomer of racemic mixture of bupivacaine), for peribulbar anaesthesia in a randomized double blind study vs.racemic bupivacaine 0.50% alone or in association with hyaluronidase 10 IU.ml-¹.
Materials and Methods: 120 patients were divided into four groups of 30 each: group L (levobupivacaine 0.50%), group B (racemic bupivacaine 0.50%), group LH (levobupivacaine – hyaluronidase10 IU.ml-¹), group BH (racemic bupivacaine – hyaluronidase10 IU.ml-¹).
Results: The onset-time (14±3.2 min vs. 13±4.8 min) and the duration of anaesthesia (195±34.2 vs. 204±37.6) were similar. The ocular akinesia was evaluated with an 8 point system: it was considered sufficient for surgery with values of less than 5 points. The association with hyaluronidase increased the spread of local anaesthetics (76.6% of group LH, 73.3% of group BH) with local anaesthetics alone (60% of group L, 56.6% of group B).
Moderate hypotension ( Statistical analysis (Student-Newman-Keuls test) was significant between group L vs. BH, B vs. BH and LH vs. BH as regards onset-time of anaesthesia; between group B vs. LH, B vs. BH and L vs. LH for the duration of anaesthesia.
Chi square test for the general akinesia score showed significant results in group L vs. LH (p=0.043) and B vs. LH 8P =0.018); as regards the score 0, test reported significant values between groups B vs. LH (p=0.004) and B vs. BH (p=0.017).
Conclusions: In conclusion levobupivacaine, a longlasting local anaesthetic with limited cardio and neurotoxicity, might be useful for vitreoretinal surgery in elderly patients, compared with general anaesthesia.

Corresponding Author: Elena Pacella, MD; e-mail: pacella.ferny@libero.it

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