Topical anesthesia with or without propofol sedation versus retrobulbar/peribulbar anesthesia for cataract extraction: prospective randomized trial.

Abstract

PURPOSE:

To evaluate the feasibility of intravenous sedation in addition to topical anesthesia during cataract extraction.

SETTING:

Helsinki University Eye Hospital, Helsinki, Finland.

METHODS:

Three hundred seventeen eyes of 291 consecutive patients having cataract surgery were prospectively randomized to receive topical (oxybuprocaine 0.4%, n = 96), combined (topical anesthesia and propofol sedation, n = 107), or retrobulbar/peribulbar (prilocaine 1.5%, n = 114) anesthesia. The intraoperative conditions were judged by the surgeon. A numerical scale (0 to 10) was used to assess the degree of pain during surgery. Outcome measures were the number of complications and adverse events registered perioperatively and 1 week postoperatively as well as Snellen visual acuity.

RESULTS:

The success of posterior chamber intraocular lens (IOL) implantation through a self-sealing clear corneal incision was 97.9%, 96.3%, and 98.2% in the topical, combined, and retrobulbar/peribulbar groups, respectively. There was no difference among the groups in pain during surgery, frequency of complications, or outcome measures. One week postoperatively, visual acuity was 20/40 or better in 81.7%, 78.5%, and 77.5% of eyes in the topical, combined, and retrobulbar/peribulbar groups, respectively. The surgeon reported significantly fewer difficulties in the retrobulbar/peribulbar group (9.8%) than in the topical (26.0%) (P =.004) or combined (21.0%) (P =.036) groups. Additional sedative/analgesic medication given intraoperatively was required significantly more often in the topical (15.6%) than in the retrobulbar/peribulbar group (2.6%) (P =.002). Patients with bilateral surgery preferred combined anesthesia over retrobulbar/peribulbar anesthesia; however, there was no significant difference in patient acceptance among groups in patients having unilateral surgery.

CONCLUSION:

Intravenous propofol sedation added to topical anesthesia did not improve the operative conditions or surgical outcome. Retrobulbar/peribulbar anesthesia ensured the best surgical conditions. Patients in all anesthesia groups reported high satisfaction. However, patients having bilateral surgery seemed to prefer combined anesthesia over retrobulbar/peribulbar anesthesia.

• Authors: H Kallio, R J Uusitalo, E L Maunuksela
• Journal: Journal of cataract and refractive surgery (J Cataract Refract Surg) Vol. 27 Issue 9 Pg. 1372-9 (Sep 2001) ISSN: 0886-3350 [Print] United States
• PMID: 11566518 (Publication Type: Clinical Trial, Comparative Study, Evaluation Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Combined
• Anesthetics, Intravenous
• Anesthetics, Local
• Hypnotics and Sedatives
• Prilocaine
• Procaine
• benoxinate
• Propofol

Topics

• Adult
• Aged
• Aged, 80 and over
• Anesthesia, Local
• Anesthetics, Combined (administration & dosage)
• Anesthetics, Intravenous (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Cataract Extraction
• Female
• Humans
• Hypnotics and Sedatives (administration & dosage)
• Lens Implantation, Intraocular
• Male
• Middle Aged
• Orbit (drug effects)
• Pain Measurement
• Patient Satisfaction
• Prilocaine (administration & dosage)
• Procaine (administration & dosage, analogs & derivatives)
• Propofol (administration & dosage)
• Prospective Studies
• Treatment Outcome
• Visual Acuity