Lidocaine-Assisted Xylocaine Jelly Anesthesia versus one Quadrant Sub-Tenon Infiltration for Self-Sealing Sclerocorneal Incision Routine Phacoemulsification

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery

BACKGROUND

Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques.

OBJECTIVES

Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status.

SELECTION CRITERIA

We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.

DATA COLLECTION AND ANALYSIS

We assessed trial quality and extracted data in the format allowing maximal data inclusion.

MAIN RESULTS

We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically significant, was probably too small to be of clinical relevance. The quality of the evidence was rated as high for intraoperative pain and moderate for pain at 24 hours. We did find differences in pain during administration of local anaesthetic (low level of evidence), and indications that surgeon satisfaction (low level of evidence) and participant satisfaction (moderate level of evidence) were less with topical anaesthesia. There was not enough evidence to say that one technique would result in a higher or lower incidence of intraoperative complications compared with the other.

AUTHORS' CONCLUSIONS

Both topical anaesthesia and sub-Tenon's anaesthesia are accepted and safe methods of providing anaesthesia for cataract surgery. An acceptable degree of intraoperative discomfort has to be expected with either of these techniques. Randomized controlled trials on the effects of various strategies to prevent intraoperative pain during cataract surgery could prove useful.

Comparison of Topical Versus Sub-Tenon's Anesthesia in Phacoemulsification at a Tertiary Care Eye Hospital

PURPOSE

To compare the effectiveness of topical and sub-Tenon's anesthesia in providing pain relief during phacoemulsification.

METHODS

This randomized controlled trial was carried out at a tertiary eye care hospital, Coimbatore, Tamil Nadu, India. Patients who underwent phacoemulsification through self-sealing clear corneal incision with foldable intra-ocular lens implantation were randomized into two groups. Group 1 (n = 100) received topical anesthesia with 0.5% proparacaine (Paracaine, Sunways India Pvt. Ltd., India) drops. Group 2 (n = 100) received sub-Tenon's infiltration with 2% lignocaine (Xylocaine, AstraZeneca Pharma India Pvt. Ltd., India). As per study criteria, patients graded the pain during administration of anesthesia, during surgery and after surgery on a visual analogue pain scale. The surgeon graded overall patient co-operation. The complications were also noted. Data analysis was performed using Statistical Package for Social Sciences version 11. Student's t-test and Chi-square test were used for comparison of variables between the groups.

RESULTS

Sub-Tenon's anesthesia provided statistically significant better intra-operative pain relief and patient satisfaction than topical anesthesiat. No statistically significant difference was noted between the two groups regarding pain during administration, postoperative pain, and surgeon satisfaction.

CONCLUSION

Sub-Tenon's anesthesia provides better pain relief than topical anesthesia during phacoemulsification.

[Direct cost of cataract surgery in public hospital]

INTRODUCTION

With more than 500,000 operations per year, cataract surgery is the most performed act nowadays in France. Several techniques can be used but the phacoemulsification after micro-incision is the most common and the purpose is to put an intraocular lens into the eye.

AIM

To approach the direct cost of the cataract surgery and to compare it to the amounts of reimbursements, and to get some epidemiological and statistical data about this surgery.

MATERIAL AND METHODS

This study is prospective; many operations were followed up in the operating room and every following data were recorded: age of the patient, type of anaesthesia, type of intraocular lens, adverse events, name of surgeon, duration of the intervention, single use material and medications used during operation and their quantity for each operation.

RESULTS

One hundred and twenty-five cataract surgeries were followed. Patients mean age was 74,1 years and the anaesthesia was topical in 87,2% of cases; only two patients had general anaesthesia. The mean duration was 42 minutes. The mean direct cost was 366 € but reached 630 € in case of capsular tear. The cost greatly varied depending on the surgeon. Two references of lens (foldable monofocal, that cost between 100 and 150 €) represented 80% of the implanted lenses.

CONCLUSION

This type of study may lead to a standardisation of surgical techniques and evaluate the proportion of supply and medications in that type of surgery.

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery

BACKGROUND

Local anaesthesia for cataract surgery can be provided by either sub-Tenon or topical anaesthesia. Although there is some work suggesting advantages to both techniques, there has been no recent systematic attempt to compare both techniques for all relevant outcomes.

OBJECTIVES

To compare the effectiveness of topical anaesthesia (with or without the addition of intracameral local anaesthetic) and sub-Tenon's anaesthesia in providing pain relief during cataract surgery.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2006, Issue 2); MEDLINE (1990 to July 2006); EMBASE (1990 to July 2006) and reference lists of articles. There were no constraints based on language or publication status.

SELECTION CRITERIA

We included all randomized or quasi-randomized studies comparing sub-Tenon anaesthesia with topical anaesthesia for cataract surgery.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We also collected adverse effects information from the trials.

MAIN RESULTS

Seven studies involving 617 patients with 742 eyes operated on were examined. Five studies used unpaired data, with a single eye operated on; two studies used paired data with both eyes operated on. The surgical technique was clear corneal incision in five studies and scleral tunnel in two. The overall quality of the studies was not high, with one study triple blind (patient, surgeon and assessor blinded to treatment group) and three others single blind. The allocation of concealment and methods of randomization were only described in two studies. Three unpaired studies showed that sub-Tenon anaesthesia provided better intra-operative pain relief than topical anaesthesia (pooled weighted mean difference (fixed) 1.28, 95% CI 0.83to 1.72). The differences in the pain scores are not necessarily clinically significant although statistically significant. The differences are not large in magnitude and are skewed to the low end of the visual analogue scale but the studies are consistent throughout in reporting more pain in the topical anaesthesia group. This was also supported by the one paired study which showed that the mean pain score in the topical group was 1.13 (SD 1.57) compared with 0.57 (SD 1.28) in the sub-Tenon group (P < 0.001). Three of the studies used a 10-point visual analogue scale, while one used a novel 5-point scale. Further support was provided by other outcome measures. Sub-Tenon anaesthesia caused more chemosis and sub-conjunctival haemorrhage although this was purely aesthetic. The more serious complication of posterior capsule tear and vitreous loss occurred twice as much in the topical group than with sub-Tenon anaesthesia (4.3% versus 2.1%).

AUTHORS' CONCLUSIONS

Sub-Tenon anaesthesia provides better pain relief than topical anaesthesia for cataract surgery.