A Comparative Study of Topical vs Retrobulbar Anesthesia in Complicated Cataract Surgery

Abstract

To evaluate and compare levels of patient discomfort and perioperative complications during phacoemulsification and implantation of a foldable intraocular lens under topical lidocaine hydrochloride and retrobulbar anesthesia in patients with cataract who also had exfoliation syndrome, uveitis, posterior synechia, phacodonesis, or previous intraocular surgery.Design: A prospective, randomized, controlled trial was carried out at 2 institutions.Participants: A total of 476 eyes of 476 patients with various well-established risk factors fulfilled the inclusion criteria. In 238 eyes, phacoemulsification was performed under retrobulbar anesthesia, while the other 238 eyes received topical anesthesia.Interventions: All patients underwent temporal clear corneal phacoemulsification and implantation of a foldable intraocular lens. Patients under retrobulbar anesthesia received a single injection (3.5-5.5 mL) of a combination of 0.75% bupivacaine hydrochloride, 2% lidocaine, and hyaluronidase into the retrobulbar space. Patients in the topical anesthesia group received a minimum of 5 doses (approximately 40 µL per dose) of 2% topical lidocaine. No intracameral injection of any anesthetic was given. Main Outcome Measures:The number of complications and adverse events. The intraoperative conditions were judged by the surgeon (P.C.J. or F.K.J.), and a 10point visual analog scale was used immediately after sur-gery to assess each patient's overall severity of intraoperative pain.Results: The overall intraoperative complication rate was 1.9% for capsular tear, 3.8% for zonular tear, 1.5% for vitreous loss, and 1.0% for iris prolapse. Apart from the incidence of vitreous loss, which was significantly (P=.041) lower in the topical anesthesia group, no statistically significant differences in intraoperative and early postoperative complications were found between the groups. A supplemental posterior sub-Tenon space injection was required in 1.3% of the topical anesthesia group and in 0.8% of the retrobulbar anesthesia group. Chemosis (2.5%), subconjunctival hemorrhage (1.7%), and periorbital hematoma (0.8%) were seen only in the retrobulbar anesthesia group. The mean±SE pain scores estimated by the patients were 0.84±1.30 in the topical anesthesia group and 0.73±1.50 in the retrobulbar anesthesia group (P=.41). Patient preference for topical anesthesia (91%) appeared to be significantly (P=.01) higher than for retrobulbar anesthesia (62%). The surgeons found anesthesia-related intraoperative difficulty to be slightly lower in the retrobulbar anesthesia group (8%) than in the topical anesthesia group (14%).Conclusions: Surgery-related complications and patient discomfort were similar for the 2 methods of anesthesia. Topical anesthesia is justified as a means of improving safety without causing discomfort to the patient even in complicated cases of cataract surgery.

Comparison of Topical Anesthesia With Peribulbar Anesthesia Small Incision Cataract Surgery

“…The lack of akinesia was not clinically significant since supplemental anesthesia was not required in any patient to continue surgery. 8 Sauder G et al (2003) in their study of 140 patients reported that about 10% of patients in the peribulbar anesthesia group had mean pain score ≥ 4 while 3% of patients in the topical anesthesia group had mean pain score ≥ 4 during administration of anesthesia (P = 0.03). The mean pain score during surgery was 1.40 ± 1.17 in the topical anesthesia group and 1.36 ± 1.26 in the peribulbar anesthesia group (P = 0.54).…”

“…The risks associated with infiltration anesthesia are periocular ecchymosis, globe perforation, ptosis, optic nerve damage, retinal vein occlusion, respiratory arrest and even brainstem anesthesia 2,6,7,8 Topical anesthesia is given in the form of drops or gel. The advantages of topical anesthesia are shorter duration of action, allowing the patient to rapidly regain sight after surgery and less pain during the administration of anesthesia.…”

Combined propofol sedation with sub-Tenon's lidocaine/mercaine infusion for strabismus surgery in adults

“…27 To evaluate the effectiveness and safety of combined propofol/sub-Tenon's anaesthesia in unilateral or bilateral strabismus surgery, the study and control groups were compared for nine parameters: (1) duration of surgery; (2) duration of anaesthesia from induction to recovery of alertness; (3) oculocardiac reflex (OCR), defined as an acute decrease in heart rate induced by pressure on the eye or traction of an EOM; (4) cardiac arrhythmia following surgery; (5) discharge time, calculated from the end of surgery to discharge from the hospital; 6) Visual Analog Scale (VAS) score (0-10) for postoperative pain, completed by the patient in the recovery room and at home during the first 24 h after surgery; (7) postoperative nausea and vomiting (PONV) episodes in the recovery room and at home in the first 24 h after surgery; (8) patient satisfaction with anaesthesia, scored on a scale of 0 (dissatisfaction) to 10 (maximal satisfaction); and (9) surgeon satisfaction, scored on a scale of 0-10.…”

Evaluation of pain during intravitreal Ozurdex injections vs intravitreal bevacizumab injections

“…[18][19][20][21] It has also been successfully used in ophthalmological studies evaluating pain associated with ocular surgery, intravitreal injections, and topical therapies. 17,[22][23][24][25][26][27][28] The patients received an explanation of the VAS before the injection, and reported immediately following the procedure the degree of pain they felt during the injection.…”