Comparison between remifentanil, propofol or both for sedation during retrobulbar nerve block

ABSTRACT

To compare between the efficacy of remifentanil and propofol and combination of both for analgesia during retrobulbar nerve block in cataract surgery. A prospective randomised double blind study conducted in King Hussein Medical Center in Royal Medical Services during the period between September 2004 and August 2005. 160 patients undergoing extra capsular cataract extraction surgery under retrobulbar anaesthesia were enrolled in the study. Patients were randomly divided into four groups [40 patients in each group] and received different drug combinations by the same anaesthetist as follows remifentanil 0.3 microgram/kg [group 1], propofol 0.5 mg/kg [group 2], remifentanil 0.3 microgram/kg and propofol 0.5 mg/kg [group 3] and saline 0.1 ml/kg as a placebo [group 4]. Patient's movement and pain were observed during the injection. Heart rate, respiratory rate and haemoglobin oxygen saturation were observed every minute for 10 minutes after the block. No significant movement occurred in group 3 during the placement of the block compared to half of the patients in the control group. The mean visual analogue score was 2.3 in group 3 compared to 6.7 in group 4. There was no significant change in mean heart and respiratory rates and haemoglobin oxygen saturation among the three study groups. Patients undergoing cataract surgery under retrobulbar anaesthesia, a combination of remifentanil 0.3 microgram/kg and propofol 0.5 mg/kg is considered to provide excellent relief of pain with least patient movement and minimal respiratory and cardiac side effects