Postoperative morbidity following cataract surgery

Abstract

SummaryTwo hundred and thirty-one patients were questioned the day ,following their cataract surgery to ascertain the incidence of postoperotii:e morbidity. One hundred and nineteen patients received local anaesthesia (LA) and I 12 received general anaesthesia (GA). There n'as a signijicant difference in the incidence of nausea (21% in GA group, 3% in LA group, p < O.Ol), sore throat (41 % GA group, 3% LA group, p < O.Ol), and bruising of' the eye (15% GA group, 39% LA group, p < 0.01). There was no significant difference in the incidence of' vomiting, headache, double vision, the severity of' postoperative pain, or the need ,for analgesia. The time hefiwe the patients drank and ate postoperatively was significantly shorter in the local Unaesthetic group (1.3 h and 1.8h LA group, 4.1 h und 6 . 7 h GA group respectively, p < 0.01). Key wordsAnaesthetic techniques, regional; retrobulbar, peribulbar. Surgery; cataract.We have shown in previous studies that local anaesthesia (LA) for cataract surgery, using either retro-or peribulbar blockade, prevents the metabolic and hormonal changes seen when surgery is performed under general anaesthesia (GA) [I], and provides better cardiovascular stability [2]. The stability conferred may be beneficial in the elderly patients who frequently undergo this type of surgery. However, it is also important to the patient how they feel after their operation and a questionnaire was devised to enquire about pain, nausea, vomiting and other common postoperative symptoms to see if either LA or GA conferred a benefit . MethodsTwo hundred and thirty-one patients having cataract surgery were investigated. They were all operated on by one surgeon and received either LA, using retrobulbar or peribulbar blockade, or GA. None of the patients was premedicated. Both retrobulbar and peribulbar blocks were undertaken using a mixture of equal volumes of 2% lignocaine and 0.75% bupivacaine without adrenaline. Patients having general anaesthesia received thiopentone and vecuronium and following tracheal intubation, the lungs were ventilated with nitrous oxide, oxygen and enflurane. N o analgesics were given intra-operatively. Analgesics, either oral paracetamol or intramuscular pethidine, were available postoperatively if required. Next morning, before discharge, the patients were questioned by the nursing staff about postoperative sequelae, using the questionnaire shown in the appendix.The forms were collected and the difference between the groups analysed using the Chi-squared test. There were more females than males in both groups (LA Results Of

Single injection peribulbar anaesthesia

“…On arrival in the anaesthetic room, a 20G cannula was placed in a vein on the dorsum of the nondominant hand and routine monitoring was established. Ocular akinesia was then measured using a simple Akinesia Score [9, 20]. Eye movement was elicited in four directions: superiorly, inferiorly, nasally and temporally.…”

“…Recognised complications of peribulbar anaesthesia include damage to intra‐orbital contents, central nervous and intravascular injection [8, 11], and unpredictable increases in intra‐ocular pressure [12–14]. The volume of the potential intra‐orbital space available for injection has been shown to vary considerably [14].…”

“…These volumes, if inadequate, will fail to produce a good block and, if excessive, may dangerously increase intra‐ocular pressure [18]. An excessive increase in intra‐ocular pressure may cause intolerable pain on injection [19], triggering of the oculocardiac reflex [11], acute ischaemic optic neuropathy and, rarely, amaurosis [8, 11].…”

“…When compared with general anaesthesia, it is more popular with surgeons [2], more cost‐effective [2, 5] and improves patient throughput [1, 4–7]. Compared with retrobulbar techniques, peribulbar anaesthesia takes longer to establish [1, 8] and requires larger volumes of local anaesthetic [1, 3, 8, 9] but has fewer complications [1, 3, 4, 8, 10, 11] and provides better patient comfort and operating conditions [3].…”

Less adrenergic activation during cataract surgery with total intravenous than with local anesthesia

“…L OCAL ANESTHESIA is associated with low costs and fast postoperative recovery ( 1). Studies of Barker et al indicate that local anesthesia for cataract surgery provides a remarkable hemodynamic and metabolic stability ( 2–5). The incidence of nausea and vomiting is also markedly reduced in patients given local rather than general anesthesia ( 4).…”