Effect of adding clonidine to lidocaine on ocular hemodynamics during sub-Tenon’s anesthesia: randomized double-blind study
Efeito da adição de clonidina à lidocaína na hemodinâmica ocular durante a anestesia subtenoniana: estudo randomizado e duplo-cego
Sigmar Aurea Cabral, Antonio Roberto Carraretto, Angela Maria Sousa, Renato Santiago Gomez
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
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
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email