Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.08.004
Brazilian Journal of Anesthesiology
Original Investigation

Effect of adding clonidine to lidocaine on ocular hemodynamics during sub-Tenon’s anesthesia: randomized double-blind study

Sigmar Aurea Cabral, Antonio Roberto Carraretto, Angela Maria Sousa, Renato Santiago Gomez

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Abstract

Introduction and objectives
Different regional anesthesia techniques for ophthalmology can have hemodynamic effects on the eye. We assessed the effects of adding clonidine to lidocaine on Intraocular Pressure (IOP), Ocular Pulse Amplitude (OPA), and Ocular Perfusion Pressure (OPP) after the sub-Tenon’s technique for cataract surgery.

Methods
The study included 40 patients randomly allocated into two groups: sub-Tenon’s blockade with Lidocaine plus Saline Solution (LS) or Lidocaine plus Clonidine (LC). IOP, OPA and OPP were measured before anesthesia, and 1, 5 and 10 minutes after the injection of anesthetic solution.

Results
There was no difference between the groups in IOP, OPA, and OPP baseline values. After the injection of the anesthetic solution, the IOP increased in both groups at minute one, with a mean difference of +4.67 mmHg (p = 0.001) and +2.15 mmHg (p = 0.013) at 5 minutes. The increase was lower in the LC group when compared to LS (p = 0.027). OPA decreased in both groups, with a baseline difference, after 1 minute, of -0.85 mmHg (p =  -0.85 mmHg (p = 0.001), and at 5 and 10 minutes with differences of -1.17 (p = 0.001) and -0.89 mmHg (p = 0.001), respectively. The highest decrease was observed in group LC in relation to group LS (p = 0.03). There was no difference in OPP in relation to baseline measurements.

Conclusions
Adding clonidine to lidocaine for sub-Tenon’s anesthesia reduced IOP and OPA without significant changes in OPP.

Keywords

Sub-Tenon’s anesthesia;  Clonidine;  Intraocular pressure;  Ocular pulse amplitude;  Ocular perfusion pressure;  Cataract surgery

References

1 K.C. Nanji, S.A. Roberto, M.G. Morley, et al. Preventing adverse events in cataract surgery: recommendations from a Massachusetts Expert Panel Anesth Analg, 126 (2018), pp. 1537-1547

2 M.J. Chua, F. Lersch, A.W.Y. Chua, et al. Sub-Tenon’s anaesthesia for modern eye surgery-clinicians’ perspective, 30 years after re-introduction Eye, 35 (2021), pp. 1295-1304

3 T. Eke, C.M. Kumar Preventing Adverse Events in Cataract Surgery: Sub-Tenon’s Block Anesth Analg., 127 (2018), pp. 68-69

4 J.A.S. Ribeiro, D.S. Ribeiro, I.U. Scot, et al. Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial PLoS One, 15 (2020), Article e0236624

5 M.J. Hartsock, H. Cho, L. Wu, et al. A mouse model of retinal ischemia-reperfusion injury through elevation of intraocular pressure J Vis Exp, 113 (2016), p. 54065

6 S.G. Coupland, M.C. Deschênes, R.C. Hamilton Impairment of ocular blood flow during regional orbital anesthesia Can J Ophthalmol., 36 (2001), pp. 140-144

7 R. Watkins, B. Beigi, M. Yates, et al. Intraocular pressure and pulsatile ocular blood flow after retrobulbar and peribulbar anaesthesia Br J Ophthalmol, 85 (2001), pp. 796-798

8 O. Findl, S. Dallinger, R. Menapace, et al. Effects of peribulbar anesthesia on ocular blood flow in patients undergoing cataract surgery Am J Ophthalmol, 127 (1999), pp. 645-649

9 B.Y. Chang, W.C. Hee, R. Ling, et al. Local anaesthetic techniques and pulsatile ocular blood flow Br J Ophthalmol, 84 (2000), pp. 1260-1263

10 S. Lung, A. Luksch, G. Weigert, et al. Influence of infusion volume on the ocular hemodynamic effects of peribulbar anesthesia J Cataract Refract Surg, 32 (2006), pp. 1509-1512

11 P. Pianka, H. Weintraub-Padova, M. Lazar, et al. Effect of sub-Tenon’s and peribulbar anesthesia on intraocular pressure and ocular pulse amplitude J Cataract Refract Surg, 27 (2001), pp. 1221-1226

12 M. Coşkun, M.C. Kağlioğlu, R. Davran, et al. Effects of sub-Tenon’s anaesthesia on ocular hemodynamics Can J Ophthalmol, 49 (2014), pp. 141-144

13 A. Savastano, S. Rizzo, M.C. Savastano, et al. Choroidal effusion and suprachoroidal hemorrhage during phacoemulsification: intraoperative management to prevent expulsive hemorrhage Eur J Ophthalmol., 26 (2016), pp. 338-341

14 A. Alwitry, Z. Koshy, A.C. Browning, et al. The effect of sub-Tenon’s anaesthesia on intraocular pressure Eye (Lond), 15 (2001), pp. 733-735

15 C.S. Govêia, E. Magalhães Ropivacaine in peribulbar anesthesia – vasoconstrictive properties Rev Bras Anestesiol., 60 (2010), pp. 495-512

16 P. Nehra, V. Oza, V. Parmar, et al. Effect of addition of fentanyl and clonidine to local anesthetic solution in peribulbar block J Pharmacol Pharmacother., 8 (2017), pp. 3-7

17 M.F. Barioni, G.R. Lauretti, A. Lauretti-Fo, et al. Clonidine as coadjuvant in eye surgery: comparison of peribulbar versus oral administration J Clin Anesth., 14 (2002), pp. 140-145

18 R. Madan, N. Bharti, D. Shende, et al. A dose response study of clonidine with local anesthetic mixture for peribulbar block: a comparison of three doses Anesth Analg., 93 (2001), pp. 1593-1597

19 H.M. Eldeen, M.R. Faheem, D. Sameer, et al. Use of clonidine in peribulbar block in patients undergoing cataract Surgery Aust J Basic Appl Sci., 5 (2011), pp. 247-250

20 V.G. Yazbeck-Karam, S.M. Siddik-Sayyid, E.L. Abi Nader, et al. Supplementation of retrobulbar block with clonidine in vitreoretinal surgery: effect on postoperative pain J Clin Anesth., 23 (2011), pp. 393-397

21 B. Khan, S.J. Bajwa, R. Vohra, et al. Comparative evaluation of ropivacaine and lignocaine with ropivacaine, lignocaine and clonidine combination during peribulbar anaesthesia for phacoemulsification cataract surgery Indian J Anaesth., 56 (2012), pp. 21-26

22 S.A. Cabral, A.R. Carraretto, M.C. Brocco, et al. Effect of clonidine added to lidocaine for sub-Tenon’s (episcleral) anesthesia in cataract surgery J Anesth, 28 (2014), pp. 70-75

23 T. Bertelmann, S. Langanke, M. Potstawa, et al. Can dynamic contour tonometry and ocular pulse amplitude help to detect severe cardiovascular pathologies? Clin Ophthalmol, 8 (2014), pp. 1317-1321

24 J.D. Stevens A new local anesthesia technique for cataract extraction by one quadrant sub-Tenon’s infiltration Br J Ophthalmol, 76 (1992), pp. 670-674

25 Y Zhao, X. Li, A. Tao, et al. Intraocular pressure and calculated diastolic ocular perfusion pressure during three simulated steps of phacoemulsification in vivo Invest Ophthalmol Vis Sci, 50 (2009), pp. 2927-2931

26 T. Iwase, T. Akahori, K. Yamamoto, et al. Evaluation of optic nerve head blood flow in response to increase of intraocular pressure Sci Rep, 8 (2018), p. 17235

27 O. Findl, K. Strenn, M. Wolzt, et al. Effects of changes in intraocular pressure on human ocular haemodynamics Curr Eye Res, 16 (1997), pp. 1024-1029

28 D.J. Kelly, S.M. Farrell Physiology and role of intraocular pressure in contemporary anesthesia Anesth Analg, 126 (2018), pp. 1551-1562

29 P. Meyer, J. Flammer, T.F. Lüscher Local anesthetic drugs reduce endothelium-dependent relaxations of porcine ciliary arteries Invest Ophthalmol Vis Sci, 34 (1993), pp. 2730-2736

30 I.P. Machado, G.C. Vasconcelos, R.S. Lopes, R.S. Gomez Ophthalmic artery resistance index after peribulbar block in the presence of epinephrine Int Ophthalmol, 41 (2021), pp. 203-210

31 D.B. Bylund, D.M. Chacko Characterization of alpha2 adrenergic receptor subtypes in human ocular tissue homogenates Invest Ophthalmol Vis Sci, 40 (1999), pp. 2299-2306

32 A. Wikberg-Matsson, U. Simonsen Potent alpha(2A)-adrenoceptor-mediated vasoconstriction by brimonidine in porcine ciliary arteries Invest Ophthalmol Vis Sci, 42 (2001), pp. 2049-2055

33 X.F. Figueroa, M.I. Poblete, M.P. Boric, et al. Clonidine-induced nitric oxide-dependent vasorelaxation mediated by endothelial alpha(2)-adrenoceptor activation Br J Pharmacol, 134 (2001), pp. 957-968

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