Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery – A Comparative Study from Hyderabad Karnataka Region

BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia

To compare peribulbar and subtenon anaesthesia in patients undergoing cataract surgery

To compare peribulbar and subtenon anaesthesia in patients undergoing cataract surgery. In a hospital based randomised comparative interventional study, patients who underwent cataract surgery were randomised into two groups, one receiving peribulbar and the other subtenon anaesthesia. Pain during administration, pain during surgery, chemosis, subconjunctival haemorrhage globe akinesia were noted and compared in the two groups. Any other complications which occur also noted. The pain during administration was significantly lesser in subtenon injection as compared to peribulbar anaesthesia. Pain during surgery was comparable in the two groups. Incidence of subconjunctival haemorrhage and chemosis was more in subtenon injection as compared to peribulbar anaesthesia. Globe akinesia was achieved more effectively in subtenon injection as compared to peribulbar injection. The subtenon anaesthesia is comparable to peribulbar anaesthesia with few additional advantages and is recommended as safe and effective alternative to peribulbar anaesthesia for cataract surgery.

Complications of classic double injection technique of peribulbar anaesthesia given in supine position before cataract surgery

Background: Peribulbar anaesthesia has almost totally replaced general anaesthesia and retrobulbar block for ocular procedures especially in adults. Peribulbar block involves injections above and below the orbit, with local anesthetic deposited within the orbit but does not enter the muscle cone. Relatively safe but it is still associated with complications which are detailed in this study. Aims and Objective: To study the complications of classic double injection technique of peribulbar anaesthesia given in supine position before cataract surgery and to find the percentage of patients achieving complete block with 7ml of anaesthetic solution given by peribulbar route. Materials and Methods: This prospective observational study was conducted on 500 patients who were admitted for undergoing cataract extraction surgery in the Department of Ophthalmology in GMC Jammu for a period of 8 months from December 2018 to July 2019. Results: It was observed that 103 patients out of 500 (20.6%) developed one or more of complications. Chemosis was the most common complication which occurred in 87 (17.4%) patients followed by subcunjunctival haemorrhage observed in 19 (3.8%) patients. Lid ecchymosis occurred in 16 (2.4%) patients. Retrobulbar haemorrhage occurred in 11 (2.2%) patients. 2 (0.4%) patients developed severe lid edema. In 2 (0.4%) patients wrong eye was given block. 1 (0.2%) patient developed CRAO. Complete akinesia was obtained in 415 (83%) patients with 7ml of block. Rest required supplementary injections. 14 (2.8%) patients did not attain full akinesia after 12ml of block. Conclusion: Peribulbar block is a relatively safe procedure for obtaining ocular analgesia and akinesia, but is still associated with complications ranging from minor lid edema and chemosis to grave events like RBH to CRAO.

Pain Perception in Cataract Surgery: Topical versus Peribulbar Anaesthesia

Introduction: The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection. Materials and methods: The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain. Results: In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p <0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p<0.001 for both genders). Conclusion: Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.

Orbital Cellulitis Post Uneventful Phacoemulsification

The aim of this study was to report a case of orbital cellulitis that occurred after routine uneventful cataract operation (Phacoemusification) under peribulbar anaesthesia in southern region of India. A complete ophthalmic evaluation, systemic evaluation, investigations, treatment and follow up of a 60 year old male patient was done. Orbital cellulits following cataract surgery is extremely rare. A timely diagnosis was made and the patient was treated with intravenous antibiotics. Patient did not have any predisposing risk factors; therefore most likely cause of cellulitis was surgical trauma during administration of the peribulbar block. This case illustrates the need for adequate skin preparation before the administration of peribulbar anaesthesia and minimal tissue trauma during the procedure

Use of topical anaesthesia and peribulbar anaesthesia in Descemets membrane endothelial keratoplasty

Introduction: In instances where peribulbar anaesthesia (PBA) cannot be used, Descemet membrane endothelial keratoplasty (DMEK) surgery can be performed under topical anaesthesia (TA). We evaluated subjective pain and post-operative outcomes of DMEK surgeries performed under PBA and TA. Methods: Sixty pseudophakic patients without history of ocular comorbidities underwent DMEK surgery under either PBA or TA. PBA was performed with a single injection of 6 mL Prilocaine Hydrochloride 2% in combination with 1500 I.U. hyaluronidase. For TA, patients were given 0.4% Oxybuprocaine eye drops followed by a 2% Lidocain Hydrochloride-Gel and an intraoperative injection of a 2% Lidocaine Hydrochloride solution into the anterior chamber. All surgeries were performed by the same surgeon. Subjective pain was measured using a visual analog scale (VAS). Secondary outcomes (BCVA, duration of surgery, endothelial density, rebubbling rate) were recorded during a follow-up period of 3 months. Results: The mean subjective pain of patients in the PBA group was 1.27 (95% CI 0.87–1.68) and 1.64 (95% CI 1.15–2.21) in the TA group. The mean duration of surgery was 402 s (95% CI 356–448) in the PBA group and 427 s (95% CI 371–483) in the TA group, p = 0.477. No major differences were observed in BCVA, endothelium density and rebubbling rate between the two groups. Anaesthesia-related side effects were more frequent in the PAB group than in the TA group. Conclusion: Although levels of subjective pain are lower under PBA than under TA, in selected patients without ocular comorbidities TA can achieve levels of pain acceptable for DMEK surgery.