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Kara Cavuoto, Howard Palte, Steven Gayer, Lalitha Sundararaman, Joyce C Schiffman, Hilda Capo; Comparing 2% Lidocaine to 2% Lidocaine with 0.4% Ropivacaine in Adjustable Suture Strabismus Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2599.
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Ropivacaine, a local anesthetic agent, may be advantageous in adjustable suture strabismus surgery because it provides longer sensory blockade than lidocaine. Our study compares lidocaine with and without ropivacaine in regards to motility recovery and sensory acquisition in adjustable suture surgery.
We conducted a prospective, double-blinded study which assigned patients to anesthetic blockade with 2% lidocaine (group 1) or 2% lidocaine with 0.4% ropivacaine (group 2). Pain assessment and Lancaster red-green testing to evaluate muscle function recovery were conducted preoperatively, and at two, four, and six hours after surgery.
Twenty-six patients were randomized to group 1 or group 2. The average age was 52.7 years (range 21-84 years). Most patients were female (76.9%). Right and left eyes were approximately equal (53.8% vs 46.2%, respectively). There was no significant difference in average pain scores on a 10 point scale between groups 1 and 2 respectively at 2 hours (2.0 vs 2.3 p=0.8), 4 hours (3.7 vs 3.4, p=0.8), 6 hours (3.7 vs 2.6 p=0.24) after block or post-adjustment (1.8 vs 1.5, p=0.7). The median time to request additional analgesia in both groups was 120 minutes (p=0.5). There was no significant difference in the return to full motility (p=0.8).
Improved understanding of the duration of the sensory and motor anesthetic block allows better selection of the appropriate anesthetic agent for adjustable suture strabismus surgery. The addition of 0.4% ropivacaine to a retrobulbar block neither demonstrates an advantage in pain control nor prolongs the return of motility in adjustable suture strabismus surgery.
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