Peribulbar anaesthesia for cataract surgery: Prilocaine versus lignocaine and bupivacaine

Purpose. Prilocaine has recently been introduced for use in ocular local anaesthesia. A prospective randomised double-masked study was undertaken to assess the efficacy of prilocaine 2% plain versus a mixture of lignocaine 1% and bupivacaine 0.5%, each with hyaluronidase. Methods. Seventy-five patients were recruited. Local anaesthetic was given by a two-injection transconjunctival peribulbar technique. Injection and perioperative pain were graded by visual analogue pain score (range 0-10). Akinesia and orbicularis function were graded by the surgeon. Results. The two anaesthetic mixtures were comparable in efficacy in producing anaesthesia and akinesia. Using the Mann-Whitney U-test for significance, pain of injection ranked as a mean of 0.88 for prilocaine and 1.03 for lignocaine and bupivacaine (p=0.48, U=635.5) Perioperative pain was ranked as a mean of 1.17 for prilocaine and 0.91 for lignocaine and bupivacaine (p=0.41, U = 629.0). Conclusions. Prilocaine is a useful alternative anaesthetic agent for eye surgery that has low toxicity and is effective without adrenaline.