Comparative Evaluation of Ropivacaine and Lignocaine with Ropivacaine, Lignocaine, and Clonidine Combination during Peribulbar Anesthesia for Cataract Surgery

  • G R Rajashree Professor, Department of Anaesthesiology
  • K Kala Senior Resident, Department of Anaesthesiology
  • Heber Anandan Senior Clinical Scientist, Department of Clinical Research
Keywords: Peribulbar block, Ropivacaine, Clonidine, Cataract surgery


Background: Peribulbar is the most commonly used technique of anesthesia in cataract surgery, and ropivacaine is a new amino amide local anesthetic with the safer pharmacological profile.
Aim: A double-blind, prospective, and randomized study carried out in our institution after getting approval from the Ethical Committee, to compare the anesthetic effects of ropivacaine with the combination of ropivacaine and clonidine in the administration of peribulbar block in cataract surgery.
Materials and Methods: A total of 80 patients of both sexes aged 40–80 years of ASA PS Ι, ΙΙ, scheduled for cataract surgery was included in this study. Patients were allocated to two groups 0f 40 each; ropivacaine, lignocaine group (R group) who received peribulbar block with 2.5 ml of lignocaine (2%) + 2.5 ml of ropivacaine (0.75%) + 50 units of hyaluronidase to a total volume of 5 ml and ropivacaine, lignocaine, clonidine group (RC group) received peribulbar block with 2 ml lignocaine (2%) + 2 ml of ropivacaine (0.75%) + 50 units of hyaluronidase +1 μg/kg of clonidine to a total volume of 5 ml. Heart rate (HR), mean arterial pressure (MAP), pulse oximetry (SpO2), intraocular pressure (IOP), and quality of peribulbar block were observed throughout the intraoperative period at regular intervals. Duration of analgesia was observed in the post-operative period.
Results: Demographic characteristics, SpO2 were comparable in both groups. The onset of sensory and motor blockade was significantly earlier in RC group. IOP does not vary significantly in both groups. The HR, MAP was on the lower side in RC group. The duration of analgesia was prolonged in RC group (6.16 h) as compared to R group (3.48 h).
Conclusion: On adding clonidine to local anesthetic agent augments early onset and prolonged offset of sensory analgesia. It also reduces the volume of local anesthetic requirement. They maintain the hemodynamic throughout the procedure.

Author Biographies

G R Rajashree, Professor, Department of Anaesthesiology

Institute of Anaesthesiology and Critical Care, Rajiv Gandhi Government General Hospital, Madras Medical College, Tamil Nadu, India

K Kala, Senior Resident, Department of Anaesthesiology

Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India

Heber Anandan, Senior Clinical Scientist, Department of Clinical Research

Dr. Agarwal’s Eye Hospital, Tamil Nadu, India


1. Khan B, Bajwa SJ, Vohra R, Singh S, Kaur R, Vartika, et al. Comparative
evaluation of ropivacaine and lignocaine with ropivacaine, lignocaine and
clonidine combination during peribulbar anaesthesia for phacoemulsification
cataract surgery. Indian J Anaesth 2012;56:21-6.
2. Demediuk OM, Ranjit SD, Papwort DP, Dhaliwal RS, Devenyi RG,
Wong DT. A comparison of retrobulbar and periocular anesthesia for
vitreoretinal surgical procedures. Arch Ophthalmol 1995;113:908-13.
3. Donlon JV Jr. Anaesthesia for Opthalamic Surgery. In: Barash P, editor.
ASA Refresher Course Lectures. Vol. 16. Philadelphia, PA: JB Lippincott;
1988. p. 81.
4. Bloomberg LB. Administration of peribulbar anesthesia. J Cataract Refract
Surg 1986;12:677-9.
5. Davis DV, Mandel MR. Efficacy and complication rate of 16,224
consecutive peribulbar block: A prospective, multicentre study. J Cataract
Refract Surg 1994;20:327-37.
6. Mjahed K, el Harrar N, Hamdani M, Amraoui M, Benaguida M. Lidocaineclonidine
retrobulbar block for cataract surgery in the elderly. Reg Anesth
7. Bajwa SJ, Bajwa S, Kaur J. Comparison of epidural ropivacaine and
ropivacaine clonidine combination for elective cesarean sections. Saudi J
Anaesth 2010;4:47-54.
8. Connelly NR, Camerlenghi G, Bilodeau M, Hall S, Reuben SS, Papale J.
Use of clonidine as a component of the peribulbar block in patients
undergoing cataract surgery. Reg Anesth Pain Med 1999;24:426-9.
9. Gillart T, Barrau P, Bazin JE, Roche G, Chiambaretta F, Schoeffler P.
Lidocaine plus ropivacaine versus lidocaine plus bupivacaine for peribulbar
anaesthesia by single medical injection. Anesth Analg 1999;89:1192-6.
10. Gioia L, Prandi E, Codenotti M, Casati A, Fanelli G, Torri TM, et al.
Peribulbar anesthesia with either 0.75% ropivacaine or a 2% lidocaine and
0.5% bupivacaine mixture for vitreoretinal surgery: A double-blinded study.
Anesth Analg 1999;89:739-42.
11. Luchetti M, Magni G, Marraro G. A prospective randomized doubleblinded
controlled study of ropivacaine 0.75% versus bupivacaine
0.5% -mepivacaine 2% for peribulbar anesthesia. Reg Anesth Pain Med