Effect of Ultra-Low-Dose-Naloxone, added to fentanyl and lidocaine for peribulbar anesthesia

Abstract

Background: Use of fentanyl in local anesthesia, as adjuvant, is known to improve the block and prolong the duration of postoperative analgesia. This study aimed to evaluate the effect of addition of ultra-low-dose of naloxone to fentanyl and lidocaine for peribulbar anesthesia on the quality of the block and the duration of postoperative analgesia on patients undergoing globe cataract surgery.

Methods: 50 adult patients, of both genders, undergoing globe cataract surgery in the Department of Ophthalmology, GMC Jammu, were studied, in collaboration with the Department of Anesthesiology, during the period December 2014 to May 2015. The patients were divided into two groups of 25 each, comparable for the patient characteristics. Group 1 patients received 50 μg fentanyl and lidocaine 2% with hyaluronidase 15 IU/ml, while, Group 2 patients received 100 ηg naloxone, 50 μg fentanyl and lidocaine 2% with hyaluronidase 15 IU/ml.

Results: No significant difference in total injected volume, onset and best akinesia score or number needing supplemental injection. Time to first rescue analgesic was significantly longer in group 2 (7.05 ± 1.04) than group 1 (4.41 ± 0.39). VAS was quite low at 30, 60, 90 min and 2 or 3 h, but increased significantly after 4 hours in Group 1. A significant increase in the IOP, 2 min after injection of the local anesthetic.

Conclusion: Addition of ultra-low-dose naloxone to fentanyl and lidocaine for peribulbar anesthesia showed significant prolongation of the time to first request for analgesic without increasing the adverse effects.