Bupivacaine and Lidocaine Retrobulbar Anesthesia

Bupivacaine 0.75% with epinephrine and/or hyaluronidase and lidocaine 2% with epinephrine and hyaluronidase were compared as to onset and duration of surgical anesthesia and akinesia in a prospective, randomized, double-blind study in 111 patients undergoing 128 elective intraocular surgical procedures. There was no significant difference in onset time to adequate surgical anesthesia among any of the drug groups at 15 minutes following retrobulbar injection, but the bupivacaine with epinephrine group lagged for akinesia. Mean duration of akinesia was 11 hours for the bupivacaine groups compared to four hours for lidocaine. During the eight hours following surgery, 70–90% of the patients receiving bupivacaine required no postoperative analgesia compared to less than 40% of the lidocaine group. There were no drug-related complications.