The effect of adding verapamil to local anesthetics in peribulbar block for intraoperative anesthesia and postoperative analgesia in vitreoretinal surgery: a randomized clinical trial

Aims To evaluate the efficacy and safety of verapamil as an adjuvant to the local anesthetics xylocaine and bupivacaine for peribulbar block in vitreoretinal surgery. Settings and design This blinded, randomized, controlled trial was carried out at the Research Institute of Ophthalmology, Egypt. Patients and methods A total of 82 eligible patients were randomly allocated into two groups. The control group received xylocaine, bupivacaine, and normal saline. Verapamil group were treated the same way as the control group but received 5 mg of verapamil instead of normal saline. The primary outcomes included the onset of sensory block, motor block, lid akinesia, duration of the block, and patients’ hemodynamics. Secondary outcomes included postoperative pain, time to first analgesia, and patient’s and surgeon’s satisfaction. Results The onset of sensory block was significantly shorter in the verapamil group compared with the control group (42.6±10.1 vs. 52.2±23.6 s, respectively; P=0.020). A significant decrease in the mean rank of VAS score was recorded at two h in the verapamil group compared with the control group (30.72 vs. 47.50, respectively; P=0.001). Otherwise, the medians of motor block and lid akinesia and the mean duration of block did not show significant differences between the two groups. Conclusions Addition of 5 mg of verapamil to a mixture of 5 ml of xylocaine 2% and 5 ml of bupivacaine 0.5% in peribulbar block significantly shortened the onset of sensory block and reduced the postoperative pain but did not affect the onset of motor block or the duration of anesthesia.