Lidocaine versus ropivacaine for topical anesthesia in cataract surgery

Abstract Purpose: To assess the anesthetic efficacy and safety of topical ropivacaine versus topical lidocaine in cataract surgery. Setting: Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy. Methods: This prospective controlled randomized double-blind study comprised 64 patients scheduled for planned routine cataract extraction. Patients were randomized into 2 groups; 1 received topical ropivacaine 1% and the other, topical lidocaine 4%. The duration of surgery, intraoperative and early postoperative complications, and the need for supplemental intracameral anesthesia were recorded. Intraoperative and postoperative subjective pain was quantified by patients using a scale from 1 to 10. An endothelial cell count was performed preoperatively and 2 months after surgery. Results: The mean endothelial cell density decreased from 2334 cells/mm 2 ± 496 (SD) to 2016 ± 674 cells/mm 2 in the ropivacaine group and from 2519 ± 404 cells/mm 2 to 1847 ± 607 cells/mm 2 in the lidocaine group. The difference in cell density between groups was not significant before ( P = .154) or after surgery ( P = .329); however, the difference in mean cell loss between groups was statistically significant ( P = .031). The duration of surgery and intraoperative complications were the same in both groups. Four patients in the ropivacaine group and 5 in the lidocaine group required supplemental anesthesia ( P > .05). The mean subjective analog pain score was slightly higher in the lidocaine group ( P > .05). The day after surgery, 12 eyes in the ropivacaine group and 6 in the lidocaine group had transient corneal edema ( P = .150). Conclusions: Topical ropivacaine performed at least as well as topical lidocaine in efficacy and safety in cataract surgery. It provided sufficient and long-lasting analgesia without the need for supplemental intracameral anesthesia in most cases.