Local Anaesthesia in Cataract Surgery

Abstract

nerves of the cornea and the conjunctiva (long and short ciliary nerves, nasociliary nerves). This technique eliminates the possible complications of injectable anesthesia. However, it does not eliminate pain sensitivity of the iris, the zonule, and the ciliary body which is achieved by intracameral technique of anesthesia with preservative free 1% lidocaine. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but there is a possibility of getting an allergic reaction. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma. INTRODUCTIONThe ideal anaesthesia would be one that provides adequate pain relief during surgery and postoepratively, be easy to administer and have minimal complications. For doing cataract surgery, the anaesthesia could be local or general. Majority of cataract patients are operated under local anaesthesia (infiltration, topical, intracameral). The infiltration anaesthesia is given as retrobulbar or peribulbar or subTenon's block. Carl Koller first used cocaine as a topical anaesthetic for eye surgery in 1884 [1] . The general anaesthesia has its own complications in elderly cataract patients and most of them may have diabetes or hypertension or heart diseases or combination of them. No need of fasting before or after surgery, no need of intubation, no need of using any systemic medications are the advantages of local anaesthesia. However, cataract in children, patients with parkinsonism, deaf mute patients, mental retardation patients, patients ABSTRACTThere has been a significant evolution in surgical technique of cataract extraction. The technical advances in phaco machines, phacotips, and availability of ophthalmic viscoelastic devices have played a great role in cataract surgery to be faster and more controlled now than before. Similarly, local anesthesia techniques in cataract surgery have also advanced significantly from retrobulbar, peribulbar, sub-Tenon's, to topical anaesthesia. Even though, the sub-Tenon's anesthesia technique reduced the risk of complications of peribulbar/ retrobulbar anesthesia but the technique is still associated with a possibility of damage to optic nerve, retrobulbar hemorrhage, and ocular muscle injury. Topical anesthesia is used to block the afferent EDITORIAL

Persistent opioid use in cataract surgery pain management and the role of nonopioid alternatives

“…Advances in cataract surgery pain management. References: a 22; b 12,22,23; c 12; d 12; e 12,23,27; f 12,23,24,28; g 12,25; h 12,23; i 12,23,24; j 12,26. MAC = monitored anesthesia care…”

Proctosigmoiditis characteristic ultrasonography and color doppler findings

“…As there have been significant advances in cataract extraction techniques over the years, there have also been major changes in anesthetic practice for cataract surgery since the first guidelines produced by the Royal College of Ophthalmologists and the Royal College of Anaesthetists in 1993. [ 4 5 ] The vast majority of cataract procedures are performed under regional anesthesia as opposed to general anesthesia, with the majority of these composed of either topical or subtenon anesthesia. [ 2 6 7 ] Historically, retrobulbar blocks were favored, delivered by the surgeon, sometimes without an anesthetist present.…”

“…[ 9 ] While this is useful in eliminating the risk of complications associated with injectable anesthesia, it does not eliminate the pain sensitivity linked to the iris or the ciliary body. [ 4 ] Topical anesthesia is quick and pain-free to administer and useful when akinesia is not an absolute requirement. [ 4 ] Topical anesthesia also allows the patient to regain sight almost immediately after surgery without the need for an eye patch.…”

“…[ 4 ] Topical anesthesia is quick and pain-free to administer and useful when akinesia is not an absolute requirement. [ 4 ] Topical anesthesia also allows the patient to regain sight almost immediately after surgery without the need for an eye patch. [ 12 13 ] While topical anesthesia has an overall low rate of complication for cataract surgery, it may not provide complete analgesia and epithelial and endothelial toxicity has been reported with its use.…”

“…[ 25 ] Subtenon anesthesia is associated with lower risks of complications, such as subconjunctival or retrobulbar hemorrhage, chemosis, optic neuropathy, scleral perforation, and injury to the extraocular muscles compared to retrobulbar anesthesia. [ 4 25 26 ] Studies comparing subtenon block with topical blocks show that the former provides more analgesia and lower rate of posterior capsule rupture, resulted in higher patient satisfaction. [ 12 27 ] With increased demand for cataract surgery, however, and the pressure toward quicker anesthesia, it is critical to formerly compare the two modalities to offer our patients the best option or at least to have not available.…”