Levobupivacaine versus bupivacaine in peribulbar block for ophthalmic surgeries: a systematic review and meta-analysis.

Objective: To compare the efficacy of levobupivacaine versus bupivacaine for peribulbar block in ophthalmic surgery.

Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Publications in MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) that compared levobupivacaine and bupivacaine for peribulbar block in ophthalmic surgery were screened for eligibility from inception through December 22, 2023. Our analyses were summarized by calculating mean differences (MD) for continuous variables and odds ratios (OR) for dichotomous variables, using either fixed-effects or random-effects meta-analysis based on the level of heterogeneity.

Results: Eight randomized control trials enrolling 800 patients were identified in the English literature published between 1998 and 2023. There was no statistically significant difference in akinesia score at 2 minutes (MD = 0.17; p = 0.12) or 10 minutes postinjection (MD = 0.02; p = 0.89). Similarly, there was no statistically significant difference between the 2 groups in terms of time of onset of the anesthetic effect (MD = 0.38; p = 0.36), postoperative diplopia (OR = 0.62; p = 0.17), incidence of systemic hypotension (OR = 1.00; p = 1.00) or verbal pain scales during the block (MD = 0.04; p = 0.66), at the end of surgery (MD = -0.01; p = 0.94) or 4 hours postoperatively (MD = -0.00; p = 0.98).

Conclusions: As a result of conducting this meta-analysis, we conclude that there is no significant difference between levobupivacaine and bupivacaine in terms of akinesia score, time to onset of anesthetic effect, verbal pain scales, postoperative diplopia, or incidence of systemic hypotension.