Skip to main content

Advertisement

Log in

Effect of clonidine added to lidocaine for sub-Tenon’s (episcleral) anesthesia in cataract surgery

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

We aimed to evaluate the duration of anesthesia, analgesia and ocular akinesia of clonidine added to lidocaine in sub-Tenon’s anesthesia in patients undergoing cataract surgery.

Methods

Forty patients were prospectively enrolled. They were randomized to two sub-Tenon’s anesthesia groups: group L (6 ml of lidocaine 2 %, 1 ml of 0.9 % saline and 25 UI/ml of hyaluronidase), and group C (6 ml lidocaine 2 %, clonidine 1 μg/kg, 1 ml of 0.9 % saline and 25 UI/ml of hyaluronidase). Duration of sensory anesthesia, ocular akinesia in all directions, akinesia of the levator palpebrae superioris and orbicularis oculi muscles, the duration of analgesia (time to the first postoperative use of analgesics), the overall use of analgesics and the presence of adverse effects were recorded .

Results

The duration of sensory anesthesia and akinesia of the four rectus, levator palpebrae superioris, and orbicularis oculi muscles was significantly longer in group C (p < 0.05). The number of patients who required analgesics was similar between the groups but the duration of analgesia was longer in group C (p < 0.05). No significant adverse effects were observed.

Conclusion

The addition of clonidine 1 μg/kg to 2 % lidocaine in sub-Tenon’s anesthesia for cataract surgery increased the duration of sensory anesthesia, ocular akinesia, and the duration of analgesia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Eke T, Thompson JR. Safety of local anaesthesia for cataract surgery: why we should look again. Eye. 2003;17:127–8.

    Article  CAS  PubMed  Google Scholar 

  2. Malik A, Fletcher EC, Chong V, Dasan J. Local anesthesia for cataract surgery. J Cataract Refract Surg. 2010;36:133–52.

    Article  PubMed  Google Scholar 

  3. Ripart J, Lefrant JY, Vivien B, Charavel P, Fabbro-Peray P, Jaussauf A, Dupeyron G, Eledjam JJ. Ophthalmic regional anesthesia: medial canthus episcleral (sub-Tenon) anesthesia is more efficient than peribulbar anesthesia: a double-blind randomized study. Anesthesiology. 2000;92:1278–85.

    Article  CAS  PubMed  Google Scholar 

  4. Guise P. Sub-Tenon’s anesthesia: a prospective study of 6000 blocks. Anesthesiology. 2003;98:964–8.

    Article  PubMed  Google Scholar 

  5. Davison M, Padroni S, Bunce C, Rüschen H. Sub-Tenon’s anaesthesia versus topical anaesthesia for cataract surgery. Cochrane Database Syst Rev. 2007; 18: CD006291.

    Google Scholar 

  6. Vohra SB, Murray PI. Sub-Tenon’s block: a national United Kingdom survey. Ophthalmic Surg Lasers Imaging. 2008;393:79–85.

    Google Scholar 

  7. Eisenach JC, De Kock M, Klimscha W. α2-Adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984–1995). Anesthesiology. 1996;85:655–74.

    Article  CAS  PubMed  Google Scholar 

  8. Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33:159–67.

    CAS  PubMed  Google Scholar 

  9. McCartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med. 2007;32:330–8.

    CAS  PubMed  Google Scholar 

  10. Pöpping DM, Elia N, Marret E, Wenk E, Tramèr MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks. Anesthesiology. 2009;111:406–15.

    Article  PubMed  Google Scholar 

  11. Mjahed K, Harrar N, Hamdani M, Amraoui M, Benaguida M. Lidocaine–clonidine retrobulbar block for cataract surgery in the elderly. Reg Anesth. 1996;21:569–75.

    CAS  PubMed  Google Scholar 

  12. Madan R, Bharti N, Shende D, Khokhar SK, Kaul HL. A dose response study of clonidine with local anesthetic mixture for peribulbar block: a comparison of three doses. Anesth Analg. 2001;93:1593–7.

    Article  CAS  PubMed  Google Scholar 

  13. Bharti N, Madan R, Kaul HL, Khokhar SK, Mishra S. Effect of addition of clonidine to local anaesthetic mixture for peribulbar block. Anaesth Intensive Care. 2002;30:438–41.

    CAS  PubMed  Google Scholar 

  14. Calenda E, Quintyn JC, Brasseur G. Peribulbar anaesthesia using a combination of lidocaine, bupivacaine and clonidine in vitreoretinal surgery. Indian J Ophthalmol. 2002;50:205–8.

    PubMed  Google Scholar 

  15. Eldeen HM, Faheem MR, Sameer D, Shouman A. Use of clonidine in peribulbar block in patients undergoing cataract surgery. Aust J Basic Appl Sci. 2011;5:247–50.

    CAS  Google Scholar 

  16. Yazbeck-Karam V, Siddik-Sayyid SM, Abi Nader EL, Barakat DE, Karam HS, Cherfane GM, Hajj Hussein JN, Aouad MT. Supplementation of retrobulbar block with clonidine in vitreoretinal surgery: effect on postoperative pain. J Clin Anesth. 2011;23:393–7.

    Article  CAS  PubMed  Google Scholar 

  17. Kumar CM, Dodds C. A disposable plastic sub-Tenon cannula. Anaesthesia. 2001;56:399–400.

    Article  CAS  PubMed  Google Scholar 

  18. Mather CM. Comparison of i.v. cannula and Stevens’ cannula for sub-Tenon’s block. Br J Anaesth. 2007;99:421–4.

    Article  CAS  PubMed  Google Scholar 

  19. Ripart J, Metge L, Prat-Pradal D, Lopez FM, Eledjam JJ. Medial canthus single-injection episcleral (sub-Tenon’s anesthesia): computed tomography imaging. Anesth Analg. 1998;87:42–5.

    CAS  PubMed  Google Scholar 

  20. Dempsey GA, Barrett PJ, Kirby IJ. Hyaluronidase and peribulbar block. Br J Anaesth. 1997;78:671–4.

    Article  CAS  PubMed  Google Scholar 

  21. Frow MW, Miranda-Caraballo JI, Akhtar TM, Hugkulstone CE. Single injection peribulbar anaesthesia. Total upper eyelid drops as an end-point marker. Anaesthesia. 2000;55:750–6.

    Article  CAS  PubMed  Google Scholar 

  22. Kopacz DJ, Bernards CM. Effect of clonidine on lidocaine clearance in vivo. A microdialysis study in humans. Anesthesiology. 2001;95:1371–6.

    Article  CAS  PubMed  Google Scholar 

  23. Li HK, Abouleish A, Grady J, Groeschel W, Gill KS. Sub-Tenon’s injection for local anesthesia in posterior segment surgery. Ophthalmology. 2000;107:41–6.

    Article  CAS  PubMed  Google Scholar 

  24. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia. 1999;54:146–65.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Renato Santiago Gomez.

About this article

Cite this article

Cabral, S.A., Carraretto, A.R., Brocco, M.C. et al. Effect of clonidine added to lidocaine for sub-Tenon’s (episcleral) anesthesia in cataract surgery. J Anesth 28, 70–75 (2014). https://doi.org/10.1007/s00540-013-1660-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-013-1660-2

Keywords

Navigation