Serious complications of local anaesthesia for cataract surgery: a 1 year national survey in the United Kingdom

Abstract

This large survey found a lower rate of reported serious complications with sub-Tenon's, topical and topical-intracameral LA compared with retrobulbar and peribulbar techniques. These "newer" methods may be preferable for routine cataract surgery.

The Cataract National Dataset Electronic Multi-centre Audit of 55 567 operations: anaesthetic techniques and complications

“…A 2003 postal survey of all UK consultants indicated that 96% of cataract surgery was carried out using LA, comprising 34% sharp needle, 43% subtenons, and 21% topical/intracameral. 4 The present study similarly found that almost 96% of cataract surgery was performed under LA, but with lower rates of sharp needle (19.5%) and higher rates of subtenons (46.9%) and topical/intracameral (27%) techniques. The authors consider that the most likely explanation for the difference between this study and the 2003 survey is a continued trend away from sharp needle techniques, as 86% of data in this study were collected between January 2004 and July 2006.…”

“…The use of local anaesthetic techniques has risen from 46% in 1990 1 to 86% in 1997 3 and 96% in 2003. 4 There have also been major changes in the local anaesthetic techniques used, with peribulbar and retrobulbar being used in 65.6 and 16.9% of cases, respectively, in the 1996 5 survey, falling to 30.6-47.7 and 0.8-3.5%, respectively, in 2003; 4,6 subtenons anaesthesia increasing from 6.7 to 16.8-42.6% and topical anaesthesia increasing from 2.9 to 9.9-33.3% over the same time period. [4][5][6] The use of sedation with local anaesthesia (LA) has fallen from 6% in 1996 5 to 3.9% in 2003.…”

“…4 There have also been major changes in the local anaesthetic techniques used, with peribulbar and retrobulbar being used in 65.6 and 16.9% of cases, respectively, in the 1996 5 survey, falling to 30.6-47.7 and 0.8-3.5%, respectively, in 2003; 4,6 subtenons anaesthesia increasing from 6.7 to 16.8-42.6% and topical anaesthesia increasing from 2.9 to 9.9-33.3% over the same time period. [4][5][6] The use of sedation with local anaesthesia (LA) has fallen from 6% in 1996 5 to 3.9% in 2003. 4,6 Day case ophthalmic surgery under LA has been shown to be safe [7][8][9] and is associated with the least disruption to the patient's normal daily activity.…”

“…[4][5][6] The use of sedation with local anaesthesia (LA) has fallen from 6% in 1996 5 to 3.9% in 2003. 4,6 Day case ophthalmic surgery under LA has been shown to be safe [7][8][9] and is associated with the least disruption to the patient's normal daily activity. 9, 10 The choice of anaesthesia depends on a number of factors, including patient psychology, the particular features of the globe and the orbit, the anticipated surgical difficulty and the experience of the operating surgeon.…”

“…In addition, there have been many documented cases of needle trauma to structures within the orbit during LA, some of which have caused significant loss of vision. 4,11,[16][17][18][19][20][21][22][23][24][25][26][27] Most of these adverse events have been reported with sharp needle techniques (retrobulbar and peribulbar anaesthesia); 4,11,[16][17][18][19][20][21][22][23][24][25][26][27] however, there have been no large randomised controlled trials to compare the safety of different local anaesthetic techniques.…”