Comparison of articaine and bupivacaine/lidocaine for peribulbar anaesthesia by inferotemporal injection

Background. Articaine is a novel amide local anaesthetic with a shorter duration of action than prilocaine. Methods. In a randomized, double-blind study we compared the efficacy of 2% articaine with epinephrine 1:200 000 with a mixture of 0.5% bupivacaine and 2% lidocaine with epinephrine 1:200 000 for peribulbar anaesthesia in cataract surgery using a single inferotemporal injection. Eighty-two patients were randomly allocated to one of two groups to receive peribulbar anaesthesia with 6-7 ml of articaine or a bupivacaine/lidocaine mixture. Both solutions contained hyaluronidase 30 iu ml(-1). Ocular movement was scored at 2 min intervals up to 10 min, at the end of surgery and at time of discharge from hospital. Time to readiness for surgery and any complications (proptosis, chemosis, pain) were recorded. Results. The articaine group demonstrated a rapid onset of peribulbar block with mean time (sd) to readiness for surgery of 4.2 (4.5) min compared with 7.2 (5.7) min in the bupivacaine/lidocaine group (P=0.0095). The block obtained in the articaine group was dense with eye movement scores at 2, 4, 6, 8 and 10 min all significantly reduced (P<0.01 at each interval). There was also a faster offset of the block in the articaine group (P=0.0009). There was no difference in incidence of minor complications between the groups. Conclusions. Two per cent articaine is safe and effective for peribulbar anaesthesia by inferotemporal injection and is a suitable alternative to the traditional mixture of 0.5% bupivacaine and 2% lidocaine.