Topical anaesthesia for cataract surgery

The Effect of Binaural Beat Audio on Operative Pain and Anxiety in Cataract Surgery under Topical Anaesthesia: A Randomized Controlled Trial

Background: The aim of this paper was to examine the analgesic and anxiolytic effects of binaural beat audio in patients undergoing cataract surgery under topical anaesthesia. Methods: This was a prospective, randomized controlled trial of 61 patients undergoing cataract surgery under topical anaesthesia. They were divided into two research conditions; the binaural beat audio group, and a sham-control group (ear phones with no music). Patients completed the State-Trait Anxiety Inventory questionnaire (STAI), and their blood pressure (BP) and heart rate (HR) were measured pre- and post-intervention. Intraoperative pain levels were ascertained using a visual analog scale (VAS) completed immediately after the surgery. Results: The binaural beat group had significantly lower pain scores (p < 0.001), HR (p < 0.001), diastolic BP (p = 0.003), mean arterial pressure (p = 0.007) and anxiety (p = 0.009) than the control group. Within the binaural beat group, subjects experienced a statistically significant reduction in HR (p = 0.004) and anxiety (p < 0.001) levels compared to baseline values, while all parameters, except anxiety, increased significantly in the control group. Conclusions: Binaural beat audio decreases operative pain and anxiety in cataract surgery under topical anaesthesia. It may have additional benefits in modulating the tachycardic response to stress.

Preferred Surgical and Anesthesia Techniques for Cataract Surgery in Jordan

Purpose

To study the current practices in Jordan regarding cataract surgical procedures and anesthesia trends for cataract surgery.

Methods

A cross-sectional survey of members of the Jordanian Ophthalmology Society was conducted in October 2020. The questionnaire included questions about participants' demographics, the preferred surgical techniques for cataracts, the preferred anesthesia technique for cataract surgery, the factors which affect the choice of anesthesia technique, the use of sedation, who gives the anesthesia, if there is an anesthesia-trained person who observes the patient during cataract surgery, and the changing trends towards anesthesia between the surgeons.

Results

More than half of the respondents (59.1%) had been in practice for more than 5 years. The preferred method for routine cataract was phacoemulsification for most participants (98.4%). For mature cataract, phacoemulsification was the preferred method for 61.4% of participants. More than half (55.1%) used topical with intracameral anesthesia for phacoemulsification. Two thirds of the participants (66.3%) performed retrobulbar anesthesia for extracapsular cataract surgery. In the majority of cases (86.6%), the respondent themself is the one who administers the anesthesia. No sedation was used before surgery in 62.6% of cases. Two thirds of the respondents (70.1%) reported that they had an anesthesia-trained person monitoring the patient during surgery. Patient cooperation was the most important factor (70.9%) affecting the surgeon's choice of anesthesia technique followed by surgeon skill and experience (57.5%).

Conclusion

Presently, phacoemulsification is the preferred surgical technique for cataract in Jordan. Topical with intracameral anesthesia is the most common anesthesia for phacoemulsification while retrobulbar anesthesia is the most common for extracapsular cataract extraction.

Satisfaction level with topical versus peribulbar anesthesia experienced by same patient for phacoemulsification

Background:

Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future.

Methods:

Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student's t-test was used to determine the significance of IOWA score in both groups. P<0.05 was considered significant.

Results:

Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant.

Conclusion:

Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.

The Lanindar test: a method of evaluating patient suitability for cataract surgery using assisted topical anaesthesia

AIM

To evaluate an office-based Lanindar (light and nociceptive interaction noting distress and response) test to assist in the assessment of patient suitability for assisted topical anaesthesia (ATA) during phacoemulsification.

METHODS

The Lanindar test was carried out at the preoperative assessment of 716 consecutive patients in the office of one of the authors (ICF). A standard desk lamp was shone in each patient's eye after pupillary dilation, while simultaneously elevating the upper eyelid digitally. A negative test indicated patient hypersensitivity to the light and aversion to digital pressure on the upper eyelid. A positive test was indicated by the patient feeling comfort and lack of blepharospasm and withdrawal in response to the light and digital pressure. chi (2) and Fisher's exact tests were used to assess the association between Lanindar results and suitability for ATA. The positive predictive value and specificity of the test as an indicator of patient suitability for ATA were calculated. Visual acuities at 1 and 4 weeks post-operative periods were compared between the ATA and ALA/GA (assisted local anaesthesia/general anaesthesia) group of patients.

RESULTS

About 86.7% were Lanindar positive and 98.9% of these patients tolerated ATA. chi (2) and Fisher's exact tests demonstrated a significant association of a positive Lanindar test with successful ATA (chi (2)=660, P<0.001, Fisher's: P<0.001). The positive predictive value and specificity of the test were 98% (95% CI=98.04-99.7%) and 93.14% (95% CI=88.23-98.04%), respectively. Visual acuity outcomes were similar in the ATA and ALA/GA groups.

CONCLUSION

The Lanindar is a simple, highly specific, office-based test to determine patient suitability for phacoemulsification under ATA.

Immediately sequential phacoemulsification performed under topical anaesthesia as day case procedures

AIMS

To evaluate the visual outcome, safety, and economic benefits of immediately sequential phacoemulsification performed under topical anaesthesia as a day case procedure.

METHODS

Immediately sequential phacoemulsification under topical anaesthesia was performed as a day case procedure on 218 eyes of 109 patients over 21 months by a single senior surgeon using intracameral antibiotics. Case notes were retrospectively analysed.

RESULTS

The final best corrected visual acuity (BCVA) was 6/9 or better in 86% of eyes with 47% achieving 6/6 or better. The incidence of intraoperative complications was 0.45%. Postoperative complications occurred in 13.8% of eyes and included refractive error >1.00D from refractive aim (6.9%). Bilateral complications occurred in 5.5% of the patients. There were no cases of endophthalmitis. The mean time from surgery to discharge was 24 days.

CONCLUSION

Immediately sequential phacoemulsification under topical anaesthesia performed as a day case procedure is not associated with an increased number of complications when compared to unilateral phacoemulsification. Under strict surgical protocol with the use of intracameral antibiotics and performed by an experienced surgeon with a good track record this procedure is safe.

A comparison of propofol and remifentanil for sedation and limitation of movement during periretrobulbar block

STUDY OBJECTIVES

To compare clinical conditions in patients sedated with propofol or remifentanil during combined peri-bulbar and retrobulbar block (PRBB) for cataract surgery.

DESIGN

Prospective, randomized, double-blind study.

SETTING

Private clinic.

PATIENTS

106 ASA physical status I and II patients scheduled for cataract surgery.

INTERVENTIONS

Patients were randomized to receive either 0.5 mg/kg propofol (Group P) or 0.3 microg/kg remifentanil (Group R) as an intravenous (IV) bolus 1 minute prior to PRBB. At the same time, patients in both groups also received 0.5 to 1 mg midazolam IV. Movement of the hands, arms, head, and eyes were counted during each stage of the procedure by an observer who was blinded to the sedation used. Heart rate (HR), blood pressure (BP), respiratory rate (RR), expiratory CO(2) (PECO(2)), and hemoglobin oxygen saturation (SaO(2)) were recorded every minute for 10 minutes after the PRBB. Anesthetic complications, recall, and the pain experienced with the block and surgery were compared between the two groups. Means and variance of the results were compared with one-way analysis of variance and Fisher's exact test.

MEASUREMENTS AND MAIN RESULTS

Movements of the hands, arms, and head were significantly greater in Group P during all stages of the block. Almost no movements were recorded in the remifentanil group. Immediately after the PRBB (1 to 6 min), HRs were higher in Group P (73 +/- 11 bpm vs. 67 +/- 10 bpm; p = 0.0075), whereas the RRs were slower in Group R for the period 1 to 5 minutes after the PRBB (16 +/- 5 breaths/min vs.14 +/- 4 breaths/min; p = 0.0206). At these times, the mean PECO(2) was higher in Group R (36 +/- 7 mmHgvs. 32 +/- 9 mmHg; p = 0.0125). Nineteen patients in the propofol group sneezed during the medial peribulbar injection compared with none in the remifentanil group. Anesthetic and surgical complications were unremarkable and similar for the two groups.

CONCLUSIONS

Respiratory depression with remifentanil was mild and not clinically significant. Remifentanil sedation for this application was superior to sedation with propofol.

Topical anesthesia versus retrobulbar block for cataract surgery: the patients' perspective

STUDY OBJECTIVES

To compare patients' perception of topical anesthesia (TA) with combined peribulbar and retrobulbar block (PRBB) for cataract surgery.

DESIGN

Prospective, randomized, controlled, cross-over observational study.

SETTING

Private clinic.

PATIENTS

98 ASA physical status I and II patients presenting for bilateral cataract surgery 1 week apart.

INTERVENTIONS

Patients were prospectively randomized to receive either TA for surgery to one eye, followed by PRBB for surgery to the other eye 1 week later, or to receive PRBB first, followed by TA for the second operation the following week. Surgery, PRBB, and TA were standard for all cases. Interviews were conducted the day following surgery by an unbiased observer unaware of the technique used. Surgical pain was estimated on a visual analog scale of 0 to 10, and the surgeon judged the difficulty of surgery based on patient compliance and cooperation on a scale of 0 to 5. Means and variance of results were compared with analysis of variance.

MEASUREMENTS AND MAIN RESULTS

Mean age was 71.45 +/- 9.76 years (mean +/- SD). Seventy patients (71.43%) preferred PRBB while 10 patients (10.20%) preferred TA (p = 0.0001). Eighteen patients (18.37%) reported no difference between the two techniques. Ninety-six patients (97.96%) were not aware of the PRBB being injected. Duration of surgery was similar for TA (11.92 +/- 3.43 min) and PRBB (10.78 +/- 3.00 min; p = 0.06). Surgery was more difficult during TA (p = 0.0004). Pain was worse during TA (p = 0.0001). Surgical and anaesthetic complications were unremarkable for both techniques.

CONCLUSIONS

Patients who experienced both TA and PRBB preferred PRBB.

Topical anesthesia: Proxymetacaine versus Amethocaine for clear corneal phacoemulsification

PURPOSE

To evaluate the use of proparacaine (Proxymetacaine) versus tetracaine (Amethocaine) as the topical anesthetic agent for phacoemulsification cataract surgery using a 3.5 mm clear corneal sutureless incision.

SETTING

Harold Wood Hospital, Romford, Essex, United Kingdom.

METHODS

This prospective study comprised 40 randomly selected patients. Twenty were given Proxymetacaine and 20, Amethocaine. The level of discomfort experienced during delivery of the topical anesthetic agent and during and immediately after surgery was measured using a pain score. During surgery, topical anesthesia was supplemented by intracameral lignocaine 1%.

RESULTS

Patients given Proxymetacaine experienced no stinging sensation during its administration; those given Amethocaine reported varying degrees of discomfort. The difference between groups was statistically significant (P < .01). There was no difference between groups in the amount of discomfort experienced intraoperatively or postoperatively.

CONCLUSION

Proxymetacaine is the topical analgesic of choice for phacoemulsification because it produced no discomfort on administration yet had the same analgesic properties as Amethocaine.