Comparison of Articaine and Bupivacaine/Lidocaine for Peribulbar Anesthesia in Cataract Surgery

Background: Articaine is an amide local anesthetic with a shorter duration of action than prilocaine. We compared the efficacy and safety of articaine 2% to a mixture of bupivacain 0.5% and lidocaine 2% for peribulbar anesthesia in cataract surgery.Method: In this double-blind randomized clinical study, 100 cataract patients were allocated in two groups to receive peribulbar anesthesia with articaine 2% or a mixture of bupivacaine 0.5% and lidocaine 2% or prilocaine 4%. In the two groups, hyaluronidase 1 0IU/ml was added to the anesthetic mixture. Ocular and eyelid movements at 2 minute intervals for 10 minutes, at the end of surgery and at time of discharge from hospital; number of supplementary injections, total volume of solution used and pain and complications during injection and surgery, and time to readiness for surgery were used as clinical end-points.Results: The articaine group demonstrated a rapid onset of peribulbar block with mean time (SD) to readiness for surgery of 4.0 (4.4) min compared with 6.9 (5.6) min in the bupivacaine/lidocaine group (p=0.0091). The block obtained in the articaine group was dense with eye movement scores at 2,4,6,8 and 10 minutes all significantly reduced (p 0.01 at each interval). There was faster offset of the block in articaine group (p=0.0008). Less supplementary injections and less local anesthetic volume was noted in the articaine group but with no statistical significance in incidence of minor compli-cations between the two groups.Conclusion: 2% articaine is safe and effective for peribul-bar anesthesia and is a good competitor to the traditional mixture of 0.5% bupivacaine/2% Lidocaine.