Sub-Tenon anaesthesia provides better pain relief than topical anaesthesia for cataract surgery.

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The use of blunt instead of sharp needles for ophthalmic local anesthesia techniques has reduced the incidence of injury to intra-orbital structures. This case review of complications from blunt needle sub-Tenon's block suggests that sight-threatening or even life-threatening complications can still occur.

Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults Patients or population: adults (aged ≥ 18 years) undergoing ophthalm ic surgery under local anaesthetic eye blocks. Setting: hospitals in the UK (4), Germ any (1), Brazil (1) and Iran (1). Intervention: local anaesthetic eye blocks containing hyaluronidase. Comparison: local anaesthetic eye blocks containing no hyaluronidase. * The risk in the intervention group (and its 95% conf idence interval) is based on the assum ed risk in the com parison group and the relative effect of the intervention (and its 95% CI). CI: conf idence interval; n.s: not statistically signif icant; RCT: random ized controlled trial; RR: risk ratio; SM D: standardized m ean dif f erence. GRADE Working Group grades of evidence High quality: we are very conf ident that the true ef f ect lies close to that of the estim ate of the ef f ect. M oderate quality: we are m oderately conf ident in the ef f ect estim ate: the true ef f ect is likely to be close to the estim ate of the ef f ect, but there is a possibility that it is substantially dif f erent. Low quality: our conf idence in the ef f ect estim ate is lim ited: the true ef f ect m ay be substantially dif f erent f rom the estim ate of the ef f ect. Very low quality: we have very little conf idence in the ef f ect estim ate: the true ef f ect is likely to be substantially dif f erent f rom the estim ate of ef f ect 1 Downgraded one level due to m arked heterogeneity with a calculated I 2 > 50%. 2 Downgraded one level f or im precision due to wide 95% conf idence intervals, ref lecting uncertainty in the direction of ef f ect estim ate. 3 Downgraded one level f or im precision and inconsistency in m easurem ent, lack of data and sm all sam ple size.

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