Topical Anesthesia—A New Approach To Cataract Surgery

Abstract

Patients undergoing cataract surgery with the use of topical anesthesia experience less pain, can return home faster, and avoid the need for an eye patch, which can cause depth perception problems. Patient education performed by the perioperative nurse significantly affects patients' experience and recovery. This article discusses the history of cataract surgery, etiology of cataract formation, and traditional anesthetic choices. The patient selection process relative to topical anesthesia is defined, and the patient's experience throughout the perioperative phases of cataract extraction is described.

Anesthesia for ophthalmic surgery

“…Patients with low pain thresholds and high anxiety levels should be considered for regional or general anesthesia. [26] Regional Anesthesia…”

Recommended Practices for Managing the Patient Receiving Local Anesthesia

“…Although it has been shown that a variety of patients can be successfully managed with a local anesthetic, local anesthesia is not appropriate for every patient or all types of surgical procedures 4 , 5 . Highly nervous, apprehensive, or excitable patients, or those who are unable to cooperate because of their mental state or age may not be appropriate candidates for local anesthesia 6 A perioperative registered nurse should perform a preoperative nursing assessment for all patients undergoing local anesthesia 3 .…”

“…The perioperative registered nurse should review the patient's history, physical examination findings, laboratory results, and other diagnostic test results as indicated. At a minimum, the perioperative registered nurse should assess the patient for pulse, blood pressure, arterial oxygen percent saturation, skin integrity, level of consciousness, temperature, and respiration; 2 allergies and sensitivities (eg, food, medications, tape, latex, prep solutions); 2 age; current medications and use of alternative/complementary therapies; NPO status (ie, when the patient last consumed solids and/or liquids by mouth); any chronic conditions such as coughs or tremors that may impede the ability of the surgeon to perform the procedure; 5 ability to tolerate the required operative position for the duration of the procedure, as well as draping that may cover the face; 5 , 6 past or present substance abuse (these conditions may require dosage adjustments for the anesthetics used); 2 , 7 weight, particularly in children; 8 the need for IV access and/or fluids based upon patient assessment data and plan of care; 9 understanding of the plan of care; ability to understand expectations for participation and ability to cooperate; 6 preoperative pain level and expectation of intraoperative and postoperative pain control; and signs and symptoms of anxiety and fear 2 3 …”

“…ability to tolerate the required operative position for the duration of the procedure, as well as draping that may cover the face; 5 , 6 …”