Sub-tenon Anaesthesia versus Intracameral Anaesthesia in Patients Undergoing Cataract Extraction: A Comparative Study of the Level of Pain, Visual Perception and Anxiety
Background: Phacoemulsification is a modern method of cataract extraction. Sub-tenon anaesthesia used to be the preferred anaesthetic technique for this procedure before intracameral anaesthesia gained its popularity in recent years. Nevertheless, many surgeons still believe that sub-tenon anaesthesia is better than topical anaesthesia. This study aimed to evaluate and compare the experiences of patients who were treated for cataract by phacoemulsification surgery using either sub-tenon or intracameral anaesthesia.
Methods: Cross-sectional study conducted at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. Participants were asked to complete a questionnaire within 1-2 hours following surgery. The questionnaires were designed to gather information on the patient’s level of anxiety, visual perception and amount of pain experienced during cataract surgery.
Results: A total of 62 patients were included in the study. Thirty-one patients received anaesthesia by sub-tenon injection, whereas another 31 patients received anaesthesia by intracameral injection. There were no significant differences in the level of pain experienced by the two groups of patients during instillation of anaesthesia and during surgery (p=0.205 and p=0.592, respectively). There were also no significant differences in terms of visual perception and anxiety levels during surgery between the two groups (p=0.178 and p=0.731, respectively).
Conclusion: Intracameral anaesthesia obviates the need for an injection during cataract surgery and is as comfortable for patients as sub-tenon anaesthesia in terms of visual perception, level of pain, and anxiety.
2. Zhao LQ, Zhu H, Zhao PQ, Wu QR, Hu QY. Topical anesthesia versus regional anesthesia for cataract surgery: A meta-analysis of randomized controlled trials. Ophthalmology. 2012 Apr;119(4):659-67.
3. Ezra DG, Nambiar A, Allan BD. Supplementary intracameral lidocaine for phacoemulsification under topical anaesthesia: A meta-analysis of randomi¬zed controlled trials. Ophthalmology. 2008 Mar;115(3):455-87.
4. Sreenivasa S, Zaffer R, Rodriguez A, Ksiazek S, Yee RD. Apnea and sei¬zures following retrobulbar local anaesthetic injection. J Clin Anesth. 2003 Jun;15(4):267-70.
5. Frieman BJ, Friedberg MA. Globe perforation associated with subtenon anaesthesia. Am J Ophthalmol. 2001 Apr;131(4):520-1.
6. Sauder G, Jonas JB. Topical versus peribulbar anaesthesia for cataract sur¬gery. Acta Ophthalmol Scand. 2003 Dec;81(6):596-9.
7. Gombos K, Jakubovits E, Kolos A, Salacz G, Nemeth J. Cataract surgery anaesthesia really better than retrobulbar?. Acta Ophthalmol Scand. 2007 May;85(3):309-16.
8. Patel BC, Burns TA, Crandall A, Shomaker ST, Pace NL, Van EA, et al. A comparison of topical and retrobulbar anaesthesia for cataract surgery. Oph¬thalmology. 1996 Aug;103(8):1196-203.
9. Boezart A, Berry R, Nell M. Topical anaesthesia versus retrobulbar block for cataract surgery: The patients’ perspective. J Clin Anesth. 2000 Feb;12(1):58- 60.
10. Rocha G, Turner C. Safety of cataract surgery under topical anaesthesia with ora sedation without anaesthetic monitoring. Can J Ophthalmol. 2007 Apr;42(2):288-94.
11. Lofoco G, Ciucci F, Bardocci A, Quercioli P, De Gaetano C, Ghirelli G, et al. Efficacy of topical plus intracameral anesthesia for cataract surgery in high myopia: Randomized controlled trial. J Cataract Refract Surg. 2008 Oct;34(10):1664-8.
12. Bijur E, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001 Dec;8(12):1153-7.
13. Tseng SH, Chen FK. A randomized clinical trial of combined topical intraca¬meral anesthesia in cataract surgery. Ophthalmology. 1998 Nov;105(11):2007- 11.
14. Abdel-Khalek A. The development and validation of Arabic form of the STAI: Egyptian results. Pers Individ Dif. 1989;10(3):277-85.
15. Schäffer J, Mehrmann M, Heymann-Schramm S, Werry H, Piepenbrock S, et al. [Perioperative anxiety and postoperative pain suppression in intraocu¬lar operations using general anaesthesia and local anaesthesia]. Anaesthe¬sist. 1988 Jan;37(1):19-23. German
16. Au Eong KG, Low CH, Heng WJ, Aung T, Lim TH, Ho SH, et al. Subjective visual experience during phacoemulsification and intraocular lens implanta¬tion under topical anesthesia. Ophthalmology. 2000 Feb;107(2):248-50.
17. Prasad N, Kumar CM, Patil BB, Dowd TC. Subjective visual experience during phacoemulsification cataract surgery under subtenon anaesthesia. Eye (Lond). 2003 Apr;17(3):407-9.
18. Wickremasinghe SS, Tranos PG, Sinclair N, Andreou PS, Harris ML, Little BC. Visual perception during phacoemulsification cataract surgery under subte¬non anaesthesia. Eye (Lond). 2003 May;17(4):501-5.
19. Ang CL, Au Eong KG, Lee SS, Chan SP, Tan CS. Patients’ expectation and experience of visual sensations during phacoemulsification under topical anaesthesia. Eye (Lond). 2007 Sep;21(9):1162-7.
20. Chung CF, Lai J, Lam D. Visual sensation during phacoemulsification and intraocular lens implantation using topical and regional anesthesia. J Cata¬ract Refract Surg. 2004 Feb;30(2):444-8.
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