Cataract surgery anaesthesia: is topical anaesthesia really better than retrobulbar?

Abstract

ABSTRACT.Purpose: To compare the effectiveness for the patient of retrobulbar anaesthesia (RBA) and topical anaesthesia (TA) in cataract surgery by phacoemulsification. Methods: We performed a prospective, randomized study on 115 patients operated at our clinic using the two anaesthesia techniques. The RBA group comprised 57 patients (20 women, 37 men; age 72 ± 10 years); the TA group comprised 58 patients (20 women, 38 men; age 74 ± 10 years). Measured parameters were: blood pressure; heart rate; blood oxygen saturation level; serum adrenaline, noradrenaline and cortisol levels; white blood cell count; indicated pain during the procedure, and pain as reported by the patient afterwards. Two psychological tests were used: the State)Trait Anxiety Inventory (STAI), and the patient-selected face-scale test. Statistical analysis was performed using Student's t-test and the chi-square test. Results were also analysed using a logistic regression model. Results: Both types of anaesthesia were adequate for the surgical procedure. In the RBA group fewer patients experienced pain during surgery (p < 0.01) and fewer recalled any perioperative discomfort. With RBA the objective parameters were more stable than with TA, and systolic blood pressure was significantly lower (p ¼ 0.01). The logistic model was able to predict perioperative pain with 93% certainty. Pain sensitivity was higher in younger patients and in patients with higher initial cortisol and noradrenaline serum levels. Conclusions: Both methods of anaesthesia are appropriate, but phacoemulsification with TA is more painful than with RBA. In hypertonic patients and younger patients who are more susceptible to pain, TA should be avoided or used in combination with individualized sedation.

Comparison of 0.5% Levobupivacaine and 0.5% Bupivacaine for Retrobulbar Anesthesia in Cataract Surgery

“…Ho we ver pha co e mul si fi ca ti on un der to pi cal or sub-Te non anest he si a can be mo re pain ful and har der to per form in an un co o pe ra ti ve pa ti ent. 9,11 The pri mary aim of this study is to com pa re the ef fi cacy of lo cal ana est he tics 0.5% bu pi va ca i ne and its iso mer 0.5% le vo bu pi va ca i ne for ac hi e vement of ret ro bul bar ana est he si a and to de ter mi ne pa ti ent and sur ge on sa tis fac ti on in ca ta ract sur gery.…”

Ophthalmological aspects of the effect of selected physical, chemical and biological agents

“…Although, psychic factors such as preoperative anxiety, fear (of the unknown), increased awareness of the procedure, education level etc. can undoubtedly influence the pain perception, to measure these parameters remains quite difficult and the correlation between them and the experienced pain is of contradiction (2,8,9,20,51). Ursea, for example registered lower anxiety level among the patients having given higher scores found the second eye surgery which would suggest the opposite of the usually experienced effect of anxiety on the pain perception.…”

“…Although, the pain scores registered with TA are slightly higher than those with periocular injections (9,39,40), still are far acceptable, and the higher patient comfort and safety during administration and the better cost-effectiveness overweighs that drawback. Though, patients' satisfaction is based on the highly favorable visual outcome, it can negatively be influenced by pain or discomfort experienced during the procedure.…”

“…patients rated the second eye procedures just as painful as the first eye operations. However, a great and significant difference could be found between T and C values for each eye procedure: the remembered pain practically was by around 50%: (1,50 We did not need to count with the influence of the surgeon's personality and experience (9,55,56) as influencing factors, since each surgery was performed by the same surgeon, by the same technique. The interval between the surgeries of the two groups was almost two years, but the surgeon operated on the patients of Group E with more than 12 years surgical experience in PhE such the impact of the time interval on the learning curve can be disregarded.…”

“…Most of the authors agree that patient discomfort is predominantly resulted from direct iris manipulation or movement of the iris diaphragm due to rapid hydrodynamic changes, and at IOL insertion (34). In contrast, Gombos (9) stated that the iris was not touched, the anterior chamber depth was stable and the pupil wasn't narrowing when the patients reported pain, consequently the intraoperative pain of cataract surgery usually doesn't originate from the receptors located in the iris or the ciliary body. (16).…”