Comparison of articaine and bupivacaine/lidocaine for sub-Tenon's anaesthesia in cataract extraction

Background. Articaine is the most widely used local anaestheticfor dental anaesthesia in Germany, Italy and The Netherlandsand has recently been introduced and licensed for dental usein the UK. We have previously shown articaine to be superiorto a standard mixture of bupivacaine 0.5%/lidocaine 2% for peribulbaranaesthesia. Sub-Tenon’s anaesthesia arguably providesa safer method of anaesthetic delivery for cataract surgery.A blunt cannula is used in this technique, thus greatly reducingthe risk of globe perforation, intrathecal injection and sight-threateningperiocular haemorrhage. Methods. We compared articaine and bupivacaine/lidocaine forsub-Tenon’s anaesthesia in cataract surgery. Results. Sub-Tenon’s anaesthesia using articaine 2% resultedin a more rapid onset of motor block compared with a bupivacaine/lidocaine(P=0.0076). Ocular movement scores were significantly lowerfrom 2 min after injection until the end of surgery (P=0.031ANOVA). Conclusion. Articaine 2% is safe and effective for sub-Tenon’sanaesthesia and is a suitable alternative to the traditionalbupivacaine 0.5%/lidocaine 2% mixture. Br J Anaesth 2004; 92: 228–30