Assessing patient satisfaction with cataract surgery under topical anesthesia supplemented by intracameral lidocaine combined with sedation

Abstract

INTRODUCTIONSignificant changes have been introduced to the techniques and instruments used for cataract surgery over the past 20 years. Such changes include phacoemulsification without corneal suture and the development of foldable intraocular lenses, which allow smaller and self-sealing incisions (1) . Additionally, a wide range of anesthetic techniques has been developed for cataract surgery during that period, including general, ophthalmic regional, and topical anesthesia (2) . ABSTRACTPurpose: Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. Methods: Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery. Results: A total of 106 patients were enroled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. Conclusions:Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.

A prospective study on elective surgical inpatient satisfaction with perioperative anaesthesia service at Ayder comprehensive specialized hospital, Mekelle, Ethiopia

“…Our study showed that the overall proportion of participants who said we were satisfied with perioperative anesthesia services in Mekelle University Ayder Comprehensive Specialized Hospital was 88.33%. This finding was low compared with other studies done abroad and home [4, 18, 19, 22]. This can be secondary to poor preoperative assessment because the patient was not included on the selection of anesthesia type, and there was poor perioperative patient handling.…”

Comparison of olive tipped and conventional steven′s cannula for sub-tenon ophthalmic anesthesia

“…The surgeon was also asked to rate his own satisfaction level about the quality of block using a subjective score with a verbal scale, from 0 (total dissatisfaction) to 10 (total satisfaction). [10] A visual analog scale (0–10) was used to assess the level of patient pain during the block and at the end of the procedure. [11] Chemosis and subconjunctival hemorrhage were noted in each eye before starting surgery.…”

Phase IV clinical study to evaluate the effects of an intracameral combined mydriatic and anesthetic agent and standard topical mydriatics and anesthetics on the ocular surface after cataract surgery

“…These findings were aligned with similar studies. 29,30 Furthermore, in other studies, patients have reported less glare and discomfort during the surgical procedure when intracameral mydriatics were used compared with topical mydriatic eyedrops. 2 The investigator's satisfaction paralleled that of the patients and was higher in the Fydrane group and based on less intraoperative pain and better comfort experienced by the patients, which were monitored during the surgery, making the procedure less technically challenging.…”