Comparison of preservative-free bupivacaine vs. lidocaine for intracameral anesthesia: a randomized clinical trial and in vitro analysis.
Abstract | PURPOSE: METHODS: In a double-masked, controlled trial, 48 eyes of 48 patients with uncomplicated age-related cataract were randomly assigned to receive bupivacaine 0.5% or lidocaine 1.0% intracamerally before phacoemulsification with a posterior chamber intraocular lens. Outcome measures such as pain, visual acuity, amount of sedation, length of surgery, pupil size, intraocular pressure, corneal clarity, and anterior chamber reaction were compared. In laboratory studies, paired rabbit corneas were evaluated by endothelial cell perfusion with either bupivacaine 0.5%, bupivacaine 0.5% and glutathione bicarbonate Ringer solution in a 1:1 ratio or bupivacaine 0.5% buffered to a pH of 7.0. The paired control corneas were perfused with glutathione bicarbonate Ringer solution and rates of corneal swelling were determined. Cell ultrastructure and viability were also evaluated. RESULTS: In the randomized trial, there was no significant difference in the pain patients had during surgery or in the early or late postoperative period. No statistically significant difference was seen between the two groups in terms of pupil size, intraocular pressure, corneal edema, anterior chamber reaction, or visual acuity immediately after the operation or on postoperative day 1. Paired rabbit corneas perfused with bupivacaine 0.5% and bupivacaine 0.5% buffered to a pH of 7.0 swelled significantly (P<.001, P = .009, respectively), and had corneal endothelial cell damage. Dilution of the bupivacaine 1:1 with glutathione bicarbonate Ringer solution prevented corneal edema and damage to the corneal endothelium. Endothelial cell viability was also decreased after perfusion of bupivacaine 0.5% (P<.001). CONCLUSIONS:
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Authors | N J Anderson, R Nath, C J Anderson, H F Edelhauser |
Journal | American journal of ophthalmology
(Am J Ophthalmol)
Vol. 127
Issue 4
Pg. 393-402
(Apr 1999)
ISSN: 0002-9394 [Print] United States |
PMID | 10218691
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Anesthetics, Local
- Preservatives, Pharmaceutical
- Lidocaine
- Bupivacaine
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Topics |
- Aged
- Aged, 80 and over
- Anesthesia, Local
(methods)
- Anesthetics, Local
(administration & dosage, adverse effects)
- Animals
- Anterior Chamber
(drug effects)
- Bupivacaine
(administration & dosage, adverse effects)
- Cataract
(complications)
- Cell Count
- Corneal Edema
(chemically induced, pathology)
- Double-Blind Method
- Endothelium, Corneal
(drug effects, ultrastructure)
- Female
- Humans
- Intraocular Pressure
(physiology)
- Lens Implantation, Intraocular
- Lidocaine
(administration & dosage, adverse effects)
- Male
- Microscopy, Electron, Scanning
- Middle Aged
- Pain, Postoperative
(prevention & control)
- Phacoemulsification
- Preservatives, Pharmaceutical
- Prospective Studies
- Pupil
(physiology)
- Rabbits
- Safety
- Visual Acuity
(physiology)
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