BJA Advance Access originally published online on August 20, 2004
British Journal of Anaesthesia 2004 93(5):683-686; doi:10.1093/bja/aeh254
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Randomized double-blind clinical trial comparing topical and sub-Tenon's anaesthesia in routine cataract surgery
1 Department of Ophthalmology, Hairmyres Hospital, Lanarkshire Acute Hospitals NHS Trust, Lanarkshire, UK. 2 Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK. 3 Highlands and Islands Health Research Institute, University of Aberdeen, Inverness, UK
* Corresponding author. St. Paul's Eye Unit, 8Z Link, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. E-mail: sathish{at}tiscali.co.uk
Background. Several local anaesthetic techniques are available for cataract surgery. Recently, topical anaesthesia has gained in popularity. A randomized trial was designed to compare patient discomfort and intraoperative complications following routine cataract surgery under topical or sub-Tenon's anaesthesia.
Methods. A randomized double-blinded placebo-controlled clinical trial of 210 patients assigned to either a sub-Tenon's group (sub-Tenon's anaesthesia with placebo topical balanced salt solution, n=140) or a topical anaesthesia group (topical anaesthesia with placebo sub-Tenon's injection of balanced salt solution, n=70) was carried out. All patients underwent phacoemulsification with intraocular lens implantation. Patients in the sub-Tenon's group received a single injection (3 ml) of a combination of lidocaine 2% (2 ml) and bupivacaine 0.75% (1 ml), and four doses of topical placebo (balanced salt solution). Patients in the topical anaesthesia group received four doses of topical proxymethocaine 0.5% and a placebo sub-Tenon's injection (3 ml) of balanced salt solution. No intracameral injection of local anaesthetic was given. A 10-point visual analogue pain scale was used preoperatively and for postoperative pain assessment immediately after the operation and 30 min postoperatively. The intraoperative complications in the two groups were recorded.
Results. The mean pain score immediately after surgery was 2.42 (SD 2.2) in the sub-Tenon's group and 3.44 (2.3) in the topical anaesthesia group (P=0.0043). The mean pain score 30 min after surgery was 1.24 (1.7) in the sub-Tenon's group and 2.25 (2.2) in the topical anaesthesia group (P=0.0009).
Conclusions. Patients undergoing cataract surgery under topical anaesthesia experience more postoperative discomfort than patients receiving sub-Tenon's anaesthesia. Surgery-related complications were similar in both groups.
This work was presented at the 21st Congress of the European Society of Cataract and Refractive Surgeons, 2003, Munich, Germany.
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  R Wormald Is one trial enough? Br J Ophthalmol, April 1, 2005; 89(4): 398 - 398. [Full Text] [PDF]
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