Comparative Clinical Outcomes of Lidocaine versus Bupivacaine in Ophthalmic Surgeries

Background; Regional anesthesia plays a pivotal role in glaucoma surgery by ensuring adequate analgesia, ocular akinesia, and patient comfort while minimizing systemic risks. Lidocaine and bupivacaine are commonly used local anesthetics in ophthalmic practice; however, their comparative clinical performance in glaucoma surgery warrants further evaluation. Objective; To compare the clinical efficacy of lidocaine and bupivacaine for regional anesthesia in patients undergoing glaucoma surgery. Methods; This comparative observational study included 60 patients (60 eyes) who underwent antiglaucomatous surgery between 2022 and 2024. Patients were allocated into two equal groups: one group received 2% lidocaine and the other received 0.5% bupivacaine for retrobulbar anesthesia combined with Van Lint facial nerve block. The primary outcomes assessed were onset and duration of anesthesia, degree of ophthalmoplegia, and intraoperative pain intensity measured using a visual analogue scale (VAS). Secondary outcomes included the need for additional sedation, hemodynamic stability, and early postoperative comfort. Results; Adequate regional anesthesia was achieved in all patients, allowing successful completion of surgery. Lidocaine provided a faster onset of anesthesia (5–7 minutes) but a shorter duration of effect (40–50 minutes). In contrast, bupivacaine showed a slower onset (10–14 minutes) with a markedly longer duration of anesthesia (approximately 3 hours) and a higher rate of complete ophthalmoplegia (70% vs 33%). Pain-free surgery was more frequent in the bupivacaine group, and mean VAS scores were lower compared with the lidocaine group, although the difference was not statistically significant (p = 0.3). Postoperative comfort was superior in patients receiving bupivacaine. Conclusion; Both lidocaine and bupivacaine are effective for regional anesthesia in glaucoma surgery. However, bupivacaine offers prolonged anesthesia, improved ocular akinesia, and greater postoperative comfort, making it a preferable option for such procedures.