[Local anesthesia for cataract surgery in adults. Retrospective study of peribulbar, subconjunctival and topical anesthesia].
OBJECTIVE
A retrospective analysis of 4 methods of local anaesthesia for adult cataract surgery compares the efficiency of: peribulbar anaesthesia injection, subconjonctival anaesthesia injection, both of these techniques and eye topical anaesthesia. No sedation is used. All patients are classified in ASA I or ASA II grade of the anaesthesiologist classification. All the surgeries are performed in an out patient center. The anaesthetic solution combines equally bupivacaine 0.5%, lidocaine 2% and hyaluronidase 250 UI. Phacoemulsification is performed through a scleral small incision.


METHODS
390 patients are separated in 4 groups. Analgesia and Akinesia are evaluated in 3 levels: total, partial and absent.


RESULTS
They show that a single peribulbar injection less of 8 ml is sufficient in 86.5% of cases. In case of a unique subconjonctival injection 2 ml are used with a rate of full success of 67.8%. When combining these 2 methods the surgery is easily possible in 97.9% of cases. A complementary subconjonctival injection is necessary in 4.9% of eyes receiving only the inferior peribulbar infiltration and in 13% of eyes anaesthezied by the single subconjonctival injection. 20.3% of eyes receiving only topical anaesthesia need a complementary subconjonctival injection during surgery. But the study covers the first series of patients operated with this new method, most of these cases are men. Results are better with experience, confidence and corneal incision.


CONCLUSIONS
Local anaesthesia is a safe procedure offering very few local and general risks. General sedation or premedication is not necessary. The choice depends on the akinesia factor which is far more difficult to obtain with so few anaesthetic volumes than the analgesia.
Lebuisson
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DA
Service d'Ophtalmologie, Centre Médico-Chirurgie Foch, Suresnes.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local / Q000379:methods*; D002387:Cataract Extraction; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
L'anesthésie locale pour la chirurgie de la cataracte de l'adulte. Etude rétrospective des anesthésies péribulbaires, sous-conjonctivales et topiques.