Topical anesthetics oxybuprocaine versus bupivacaine 0.5% in intravitreal injections

Aim This study aimed to compare the efficacy and safety of the local anesthetic bupivacaine 0.5% and oxybuprocaine hydrochloride 0.4% used topically to provide surface anesthesia before intravitreal injection (IVI) procedures. Settings and design This double-blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods This trial included diabetic patients with glycated hemoglobin less than 7.5 mmol/l of both sexes, aged from 30 to 70 years, American Society of Anesthesiologists I, II, or III, who had central retinal vein occlusion and choroidal neovascularization. A total of 110 eligible patients were randomly allocated into two groups. Patients in group A received bupivacaine 0.5%, while those in group B received oxybuprocaine hydrochloride 0.4%. Both drugs were topically applied, three times, at 5 min intervals, for 15 min, which was followed by the IVI. The primary outcome was pain during the injection and the secondary outcome was corneal adverse effects. Results The frequency of pain-free IVI was equal in both groups (83.6% each, P=0.100). The difference in the mean heart rate after injection between groups A (81.4±12.7) and B (82.5±15.6) was nonsignificant (P=0.678). The rate of corneal side effects in terms of opacity or allergy to the topically applied drugs was nonsignificantly lower in group A compared with group B (9.1 vs. 12.7%, P=0.541). Conclusions The topical use of bupivacaine 0.5% had anesthetic efficacy similar to that of oxybuprocaine hydrochloride 0.4% during the IVI. Both the topical anesthetics were well tolerated by patients.