From the Research
Ropivacaine has a high success rate of approximately 99.1% in achieving adequate anesthesia for ophthalmic surgery patients, as seen in a study comparing ropivacaine 1% to lidocaine 2% for phacoemulsification under topical anesthesia 1. When used for ophthalmic regional blocks, ropivacaine is typically administered at concentrations of 0.75% to 1%, with volumes ranging from 2-5 ml depending on the specific block technique (retrobulbar, peribulbar, or sub-Tenon's). The onset of action is relatively quick, occurring within 5-10 minutes, with a duration of action lasting 6-8 hours. Ropivacaine is often preferred over other local anesthetics like bupivacaine for ophthalmic procedures because it provides effective sensory block with less motor blockade and reduced cardiac toxicity. For optimal results, proper technique is essential, and some practitioners add adjuvants such as hyaluronidase to improve tissue penetration and spread of the anesthetic. Patient factors such as anatomy, previous surgeries, and individual variations in response to local anesthetics can influence success rates, but overall, ropivacaine demonstrates reliable efficacy for ophthalmic anesthesia when administered correctly. Some key points to consider when using ropivacaine for ophthalmic surgery include:
- The use of 0.75% or 1% concentrations of ropivacaine for peribulbar block, as these concentrations produce quick and deep sensory and motor block of the operated eye 2.
- The addition of hyaluronidase to improve tissue penetration and spread of the anesthetic 3.
- The comparison of ropivacaine to other local anesthetics, such as bupivacaine, in terms of efficacy and safety 4. It's worth noting that the most recent study 4 from 2019, found that ropivacaine 0.5% and lidocaine 2% as a 1:1 mixture in a volume of 8 ml with 100 IU of hyaluronidase is as effective as a 1:1 mixture of bupivacaine 0.5% and lidocaine 2% in a volume of 8 ml with 100 IU of hyaluronidase with regards to onset and total duration of the block and side effects and hemodynamic changes. However, the study with the highest success rate of ropivacaine is still the one from 2002 1, which found a success rate of 99.1%.