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Topical or regional anesthesia for cataract surgery?

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In patients undergoing cataract surgery, topical anesthesia doesn’t provide the same degree of pain relief as regional anesthesia although it’s associated with fewer complications and patients seem to prefer it, a meta-analytic review of relevant research suggests.

Phacoemulsification with intraocular lens implantation is the current standard of care procedure for adult cataract surgery, the authors note in a report online February 23 in Ophthalmology. The most commonly used anesthetic techniques are retrobulbar anesthesia (RBA), peribulbar anesthesia (PBA), and topical anesthesia, but the literature comparing these approaches is mixed.

This led Dr. Huang Zhu and colleagues from Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China to perform a systematic view and meta-analysis of 15 randomized controlled trials that compared phacoemulsification under topical anesthesia (1,084 eyes) or RBA/PBA (1,121 eyes).

The researchers report that patients’ perception of pain during and after surgery was significantly higher in those who got topical anesthesia (p<0.05). This group also had more frequent inadvertent eye movement (p<0.05) and a greater need for additional anesthesia during the procedure (p=0.03). Despite this, patients significantly preferred topical anesthesia to regional anesthesia (p<0.00001), perhaps because they had fewer complications.

The RBA/PBA group had more frequent anesthesia-related complications, such as chemosis, periorbital hematoma, and subconjunctival hemorrhage (p< 0.05). There was no statistically significant difference in surgery-related complications or in intraoperative difficulties as assessed by the surgeons and there were no differences in surgical outcomes with topical anesthesia and regional anesthesia.

“Topical anesthesia reduces injection-related complications and alleviates patients’ fear of injection,” the authors note in their report. However, they say topical anesthesia “is not suitable for patients with a higher initial blood pressure or greater pain perception.” In these cases, topical anesthesia alone “should be avoided,” they write.

Summing up, they say there is not one type of anesthesia that is right for all potential cases. The best choice may vary from surgeon to surgeon on the basis of experience and predilection, and from patient to patient, they conclude.


Topical Anesthesia versus Regional Anesthesia for Cataract Surgery: A Meta-Analysis of Randomized Controlled Trials

Ophthalmology 2012.