|Year : 1982 | Volume
| Issue : 4 | Page : 263-267
"Evaluation of Marcain (bupivacain hydrochloride) as a local anaesthetic in ophthalmology"
B Shukla, Ulka Mokhariwale, Binoo Khanna, AK Vaidya
Dept. of Ophthalmology, G. R. Medical College, Gwalior, India
Dept. of Ophthalmology, G. R. Medical College, Gwalior
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla B, Mokhariwale U, Khanna B, Vaidya A K. "Evaluation of Marcain (bupivacain hydrochloride) as a local anaesthetic in ophthalmology". Indian J Ophthalmol 1982;30:263-7
|How to cite this URL:|
Shukla B, Mokhariwale U, Khanna B, Vaidya A K. "Evaluation of Marcain (bupivacain hydrochloride) as a local anaesthetic in ophthalmology". Indian J Ophthalmol [serial online] 1982 [cited 2020 Mar 28];30:263-7. Available from: http://www.ijo.in/text.asp?1982/30/4/263/29445
Most surgeons in India prefer to do intraocular operations under local anaesthesia. Xylocaine 2% (Lignocaine) in most commonly used for infiltration anaesthesia which includes facial block and retrobulbar block. Marcain (Bupivacain Hcl 5%) has been recently introduced by Sarabhai Chemicals for infiltration anaesthesia. Although the effect of marcain in spinal anaesthesia has been studied by various workers" 2, no controlled studies are available for its effects in facial and retrobulbar blocks. The present study aims to evaluate the efficacy of marcain in facial and retrobulbar block as compared to xylocaine with and without adrenaline.
| Materials and methods|| |
In the present study 55 cases were taken and divided in three groups [Table - 1]. Group I included cases with plain xylocaine, Group II xylocaine with adrenaline (1 in 50 thousand) and Group II included marcaine. The degree of facial block was studied by measuring the width of palpebral fissure by a metallic miliMeter Scale. The width ranges from 10 to 0 mm further action of orbicularis oculi was measured by noting the degree of squeezing which is upto -10 m. 5mm was taken for moderate squeezing and -10 mm for from squeezing. Thus the strength of orbicularis oculi muscle was measured in 20 steps. 100% strength of muscle which means firm squeezing whereas 0 indicated complete paralysis of muscle hence no change in palpebral fissure. The effect of drug was noted by finding the difference in the palpebral fissure before and after injecting the drug to block the facial nerve [Table - 7] when patient was asked to squeeze as much as he could.
The effect was noted in each group after 1, 2, 5,15,30,60 and 90 minutes. It was further studied in two Sub-groups `A' `&W 'B' [Table - 3][Table - 4]. Sub-Group A included 4 cc. facial block with l cc R. B. block wheras Sub-group B included 5 cc facial block with 1.5 cc of retrobulbar Block.
The effect of drug in R. B. block was studied by noting degree of dilatation of pupil and fall of ocular tension. The difference in pupillary diameter was noted before and after giving R. B. block at 1, 2, 5,15,30,60 & 90 minutes by a pupilometer under constant illumination. The difference in size by 5 m was graded as 100% and difference by t as 20% [Table - 8].
Similarly, the difference in tension was noted before and after retrobulbar block at 5 & 15 minutes interval. Fall by 10 mm Hg was graded as 100% whereas fall by I mmHg was graded as 10% [Table - 9]. These effects were studied in all the three groups and in each Sub-group.
| Observations|| |
The data recorded has been shown in [Table - 1][Table - 2][Table - 3][Table - 4][Table - 5][Table - 6][Table - 7][Table - 8][Table - 9].
| Discussion|| |
From the above study one can draw some tentative conclusions. It is observed that the effect of Plain Xylocaine (XA) is very quick but it tapers off in short time. The effect of Xylocaine with adrenaline is also quick but does not taper off so quickly. In 4 cc dose (Sub-group A) the effect of marcaine is very little but in Sub-Group B it become effective after a little period (30 minutes).
As far as R. B. block is concerned the changes in pupil are more consistent than changes in ocular tension. The degree of dilatation of pupil is maximum with Xylocaine and adrenaline in Sub-Group A. whereas it is maximum by plain xylocaine in sub-group B.
The effect of marcaine is much more in subgroup B. (1.5 cc) than sub-group A (I c.c). The study of ocular tension reveals that maximum fall of tension occurs in group-1I in both the sub-groups.
The present study indicates that marcaine is not very effective if given in 4 cc dose for facial and 1 cc dose as retrobulbar block as compared with xylocaine with or without adrenaline. However, its efficacy increases rapidly if the dose is increased from 4 to 5 cc in facial and 1 to 1.5 cc in retrobulbar block. It is possible that it may be more effective if given in doses of E6 and 2 cc for facial and R.B. block respectively. However, it should be remembered that whereas xylocaine is used as 2%, marcaine is used only as 0.5% hence slight increase in dose does notnecessarily imply that it is less effective than xylocaine. The effect of marcaine becomes more evident as time passes.
| Acknowledgement|| |
I am grateful to Dr. I. P. Agarwal, Dean G. R. Medical College, Gwalior and Dr. S.P. Srivastava Professor of ophthalmology for their permission and encouragement to carrry out this work. I am also grateful to Dr. R. K. Srivastava and Dr Miss Uma Singh for their help.
| References|| |
Jha, B. K., 1976, Ind. J. Anaesth. 24 : 324.
Jha, B. K., Shah,, C, S. Shah, S. K., 1981, Ind J. Anaesth (in publication).
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9]