• Enrico Martini, Gian Maria Cavallini, Luca Campi, Norma Lugli, Giovanni Neri, and Paolo Molinari.
• Institute of Ophthalmology, University of Modena and Reggio Emilia, Azienda Ospedaliera Policlinico di Modena, Modena, Italy.
• J Cataract Refract Surg. 2002 Jun 1;28(6):1018-22.

PurposeTo assess the anesthetic efficacy and safety of topical ropivacaine versus topical lidocaine in cataract surgery.SettingInstitute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy.MethodsThis prospective controlled randomized double-blind study comprised 64 patients scheduled for planned routine cataract extraction. Patients were randomized into 2 groups; 1 received topical ropivacaine 1% and the other, topical lidocaine 4%. The duration of surgery, intraoperative and early postoperative complications, and the need for supplemental intracameral anesthesia were recorded. Intraoperative and postoperative subjective pain was quantified by patients using a scale from 1 to 10. An endothelial cell count was performed preoperatively and 2 months after surgery.ResultsThe mean endothelial cell density decreased from 2334 cells/mm(2) +/- 496 (SD) to 2016 +/- 674 cells/mm(2) in the ropivacaine group and from 2519 +/- 404 cells/mm(2) to 1847 +/- 607 cells/mm(2) in the lidocaine group. The difference in cell density between groups was not significant before (P =.154) or after surgery (P =.329); however, the difference in mean cell loss between groups was statistically significant (P =.031). The duration of surgery and intraoperative complications were the same in both groups. Four patients in the ropivacaine group and 5 in the lidocaine group required supplemental anesthesia (P >.05). The mean subjective analog pain score was slightly higher in the lidocaine group (P >.05). The day after surgery, 12 eyes in the ropivacaine group and 6 in the lidocaine group had transient corneal edema (P =.150).ConclusionsTopical ropivacaine performed at least as well as topical lidocaine in efficacy and safety in cataract surgery. It provided sufficient and long-lasting analgesia without the need for supplemental intracameral anesthesia in most cases.

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