INTRODUCTION: Cataract surgery is one of the most commonly performed surgery in the elderly
patients. Regional anesthesia is safe, reliable, provide adequate akinesia and analgesia of the eye, a
good postoperative pain relief and a shorter hospital stay. The various regional anesthetic techniques used in ophthalmic
surgeries are peribulbar block, retrobulbar block, sub tenon's block, subconjunctival block and topical corneo-conjunctival
anesthesia. Due to its safer approach, the peribulbar block is most commonly. Addition of an opioid like fentanyl to the
anesthetic preparation will provide a faster onset of lid and globe akinesia, faster onset of sensory blockade, increase the
duration of analgesia and reduce the need for rescue analgesia postoperatively.
AIM OF THE STUDY: To evaluate the effect of addition of fentanyl to the local anesthetic mixture in peribulbar block in cataract
surgery.
MATERIALS AND METHODS: This study was done in the Department of Anesthesiology in collaboration with the Department
of Ophthalmology in Kanyakumari Government Medical College from January 2019 to December 2019. Patient posted for
cataract surgery were allocated into two groups by randomization (30 each). Group S – 4ml of 2% lignocaine with adrenaline
premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 0.5ml normal saline. Group F – 4ml of 2% lignocaine with
adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 25 mcg Fentanyl (0.5 ml). The Parameters related to the
study such as Onset of lid akinesia, Onset of globe akinesia, Onset of sensory blockade, Duration of analgesia by VAS score,
Level of sedation by Ramsay sedation score, vital parameters – SpO , pulse rate, respiratory rate, blood pressure and any 2
Complications were recorded.
RESULTS: We found that the demographic parameters were comparable and statistically insignicant. The preoperative
hemodynamic parameters like the systolic and diastolic blood pressure, pulse rate, SpO2, respiratory rate were statistically
insignicant and comparable. The mean onset of lid akinesia was 5.8 ± 1.76 mins and 3.13 ± 1.25 mins in Group S and Group F
respectively. The mean onset of globe akinesia was found to be 7.46 ± 2.22 mins and 4.2 ± 1.60 mins in Group S and Group F
respectively. The mean onset of sensory blockade was 6.8 ± 1.24 mins and 4.93 ± 1.63 mins in Group S and Groups F
respectively. Thus the onset of globe and lid akinesia and the onset of sensory blockade was faster in Group F compared to
Group S. The mean VAS scores were statistically signicant (P<0.001) between both the groups at 1 hour, 1.5 hour, 2 hour, 4
hour, 6 hour postoperatively and it was found that Group F has a lower VAS score when compared with Group S. The VAS score
at 8 hour and 10 hours postoperatively were statistically insignicant (p>0.05) in both the groups. The mean duration of
analgesia was 4.56 ± 1.65 hours in Group S and 7.63 ± 2.55 hours in Group F and was found to be statistically
signicant(P<0.001).
CONCLUSION: Based on this study, we can conclude that there is a faster onset in the lid akinesia, globe akinesia, in the onset
of sensory blockade and a substantial increase in the duration of analgesia when fentanyl is used as an additive along with the
local anesthetic mixture in peribulbar block for cataract surgery
Comparison of orbital muscle akinesia caused by rocuronium versus hyaluronidase mixed to the local anesthetic in single injection peribulbar block for cataract surgery
