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Impressum
Topical versus parabulbar anesthesia for cataract surgery
Sauder G., Jonas J. B.
Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany
Objective: To assess and compare efficacy and safety of topical
versus parabulbar anesthesia in patients undergoing routine cataract surgery.
Methods: The unicenter, prospective, randomized, clinical interventional
trial included 140 consecutive patients undergoing routine cataract surgery
performed by one of two surgeons. The patients were randomly distributed
to either parabulbar anesthesia or topical anesthesia. Parabulbar anesthesia
was performed by injecting 8 ml mepivacaine 2% parabulbarly. Patients
operated on in topical anesthesia received oxybuprocaine 0.4% eye drops
installed five times starting 10 minutes prior to surgery. No intracameral
injection of any anesthetics was given. Cataract surgery was performed
using the clear cornea technique with implantation of a foldable intraocular
posterior chamber lens. To assess intraoperative pain, each patient was
asked immediately after surgery to quantitate his/her pain using a 10
point pain rating scale.
Results: Both study groups did not differ significantly in the
pain score (P=0.54), duration of surgery (P=0.52), anesthesia-related
intraoperative difficulties (p=0.17), postoperative visual acuity (P=0.94),
overall intraoperative surgical complication rate, blood pressure rise
(P=0.16), and satO2 (P=0.74). 5 of 69 (7,25 %) patients with parabulbar
anesthesia required additional topical anesthesia, while none of the patients
with topical anesthesia required a subconjunctival or parabulbar injection
of a local anesthetics. Chemosis, subconjunctival hemorrhage, and periorbital
hematoma were seen only in the retrobulbar anesthesia group.
Conclusions: Patient comfort and surgery-related complications
did not differ between topical anesthesia and parabulbar anesthesia. Anesthesiarelated
complications occurred significantly more often in the group with parabulbar
injections. In view of the minimal invasive character of topical versus
parabulbar anesthesia, the present study suggests to use topical anesthesia
for routine cataract surgery.