A comparative study of topical vs retrobulbar anesthesia in complicated cataract surgery.
نویسندگان
چکیده
OBJECTIVES To evaluate and compare levels of patient discomfort and perioperative complications during phacoemulsification and implantation of a foldable intraocular lens under topical lidocaine hydrochloride and retrobulbar anesthesia in patients with cataract who also had exfoliation syndrome, uveitis, posterior synechia, phacodonesis, or previous intraocular surgery. DESIGN A prospective, randomized, controlled trial was carried out at 2 institutions. PARTICIPANTS A total of 476 eyes of 476 patients with various well-established risk factors fulfilled the inclusion criteria. In 238 eyes, phacoemulsification was performed under retrobulbar anesthesia, while the other 238 eyes received topical anesthesia. INTERVENTIONS All patients underwent temporal clear corneal phacoemulsification and implantation of a foldable intraocular lens. Patients under retrobulbar anesthesia received a single injection (3. 5-5.5 mL) of a combination of 0.75% bupivacaine hydrochloride, 2% lidocaine, and hyaluronidase into the retrobulbar space. Patients in the topical anesthesia group received a minimum of 5 doses (approximately 40 microL per dose) of 2% topical lidocaine. No intracameral injection of any anesthetic was given. MAIN OUTCOME MEASURES The number of complications and adverse events. The intraoperative conditions were judged by the surgeon (P.C.J. or F.K. J.), and a 10-point visual analog scale was used immediately after surgery to assess each patient's overall severity of intraoperative pain. RESULTS The overall intraoperative complication rate was 1.9% for capsular tear, 3.8% for zonular tear, 1.5% for vitreous loss, and 1.0% for iris prolapse. Apart from the incidence of vitreous loss, which was significantly (P =.041) lower in the topical anesthesia group, no statistically significant differences in intraoperative and early postoperative complications were found between the groups. A supplemental posterior sub-Tenon space injection was required in 1.3% of the topical anesthesia group and in 0.8% of the retrobulbar anesthesia group. Chemosis (2.5%), subconjunctival hemorrhage (1.7%), and periorbital hematoma (0.8%) were seen only in the retrobulbar anesthesia group. The mean + SE pain scores estimated by the patients were 0.84 + 1.30 in the topical anesthesia group and 0.73 + 1.50 in the retrobulbar anesthesia group (P =.41). Patient preference for topical anesthesia (91%) appeared to be significantly (P =.01) higher than for retrobulbar anesthesia (62%). The surgeons found anesthesia-related intraoperative difficulty to be slightly lower in the retrobulbar anesthesia group (8%) than in the topical anesthesia group (14%). CONCLUSIONS Surgery-related complications and patient discomfort were similar for the 2 methods of anesthesia. Topical anesthesia is justified as a means of improving safety without causing discomfort to the patient even in complicated cases of cataract surgery. Arch Ophthalmol. 2000;118:1037-1043
منابع مشابه
Efficacy and Performance of Various Local Anesthesia Modalities for Cataract Surgery
Progression in phacoemulsification techniques for cataract surgery[1-4] has also led to inevitable changes in the delivery of accompanying anesthesia from general to local modalities [5-7] i.e. retrobulbar, peribulbar, Sub-Tenon and topical anesthesia. General anesthesia is preferred for complicated intracapsular cataract extraction (ICCE) surgery as this technique involves significant manipula...
متن کاملComparison of sedation requirements for cataract surgery under topical anesthesia or retrobulbar block.
PURPOSE Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patie...
متن کاملComparing the Effect of Topical Anesthesia and Retrobulbar Block With Intravenous Sedation on Hemodynamic Changes and Satisfaction in Patients Undergoing Cataract Surgery (Phaco Method)
BACKGROUND Cataract is one of the most common surgical procedures in the elderly. In most cases, the elderly have cardiac ischemia or chronic coronary diseases, which would lead to more ischemic events during general anesthesia. Therefore, surgeons and anesthetists prefer regional aesthesia to the general one owing to its more advantages and less complications. OBJECTIVES Therefore, this stud...
متن کامل361-367 Erdurmus:Shoja
For many years, retrobulbar and peribulbar anesthesia were the standard for cataract surgery; however, many serious adverse effects have been reported (1, 2). With the introduction of modern phacoemulsification cataract surgery, topical anesthesia without retrobulbar or periocular injections has become a well-established, minimally invasive technique (3). The addition of intracameral lidocaine ...
متن کاملSuperior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial
PURPOSE To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS) performed by third-year residents. DESIGN A randomized, controlled trial. PATIENTS AND METHODS A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anes...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Archives of ophthalmology
دوره 118 8 شماره
صفحات -
تاریخ انتشار 2000