Clinical Comparison of Bupivacaine and Lidocaine for Local Anesthesia in Glaucoma Surgery

Aims: To compare the clinical efficacy of bupivacaine and lidocaine for regional glaucoma surgical anesthesia.

Study Design: Cross-sectional comparative analysis

Place and Duration of Study: Department of Ophthalmology, clinic of Tashkent Medical Academy, between 2022 and 2024.

Methodology: We included 60 patients (60 eyes) with glaucoma; 28 men and 32 women; age range was 45-80 years. The patients were divided into two groups: 1st - 30 patients with lidocaine anesthesia and 2nd - 30 patients with bupivacaine anesthesia. The criteria for comparing the groups were: The rapidity of regional anesthesia, its duration, the general well-being of patients, the intensity of pain during the operation and in the early postoperative period on a visual analogue scale.

Results: In all patients of the 1st group anesthesia was achieved within 5-7 minutes, its duration was 40-50 minutes. In the second group anesthesia came later, after 10-14 minutes, but its duration was much longer, averaging 3 hours. Full ophthalmoplegia was received in 10 patients (33%) of the 1st group, and 21 patients (70%) of the 2nd group. Fifteen patients with bupivacaine and twelve patients with lidocaine had no pain during surgery. 8 (13%) patients experienced moderate pain (3-5 points). Five of them were operated under lidocaine anesthesia, three of which were operated with bupivacaine. Three patients experienced severe pain (6-10 points). Of these, two patients were operated on with lidocaine, and only one patient was operated. The average pain intensity was 2.0 ±0.4, and 1.4 ±0.3 with lidocaine and bupivacaine, respectively. Statistically significant differences between these groups for intraoperative pain syndrome are not obtained (p = 0.3).

Conclusion: Good analgesic effect was achieved in all patients of both groups. Anesthesia with lidocaine occurs quickly, and anesthesia with bupivacaine is longer and better. The use of bupivacaine was associated with lower pain levels due to the longer duration of anesthesia, which has improved the quality of life.