title: Patient comfort during cataract surgery with modified topical and peribulbar anesthesia.
abstract: OBJECTIVE
  To evaluate patient comfort during cataract surgery performed using modified topical and peribulbar anesthesia.
  
  
  METHODS
  Sunderland Eye Infirmary Cataract Treatment Centre, Sunderland, United Kingdom.
  
  
  METHODS
  In this prospective study, 50 consecutive patients scheduled for cataract surgery with local anesthesia were randomly assigned to receive topical bupivacaine hydrochloride plus 0.1 mL subconjunctival lignocaine or standard peribulbar anesthesia. All surgery was performed by one surgeon using a scleral pocket bimanual phacoemulsification technique. Patients were asked to grade the pain experienced during administration of the anesthetic and during cataract surgery using a visual analog scale.
  
  
  RESULTS
  No statistically significant difference in patient comfort was demonstrated between the two groups during cataract surgery (P < .4, Wilcoxon rank-sum test), and all patients were satisfied with the anesthesia. However, administration of topical bupivacaine was significantly less painful than peribulbar injections (P < .001, Wilcoxon rank-sum test). In eight patients in the topical anesthesia group, the cataract in the fellow eye was removed using peribulbar anesthesia; seven of these patients stated a preference for the modified topical method, while one patient thought there was no difference between the two methods. There was no difference between the groups in surgical complications, but 24% of the peribulbar group had a minor subconjunctival hemorrhage at the needle entry site.
  
  
  CONCLUSIONS
  The modified topical technique provided satisfactory patient comfort during cataract surgery; it was comparable to the comfort achieved using peribulbar injections. The speed and ease of administering topical anesthesia coupled with the rapid visual recovery after surgery makes this method a suitable and safe choice for day-case phacoemulsification cataract surgery.
authors.affiliation: Ophthalmology Department, West Norwich Hospital, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Maclean
authors.forename: T
authors.initials: T
authors.lastname: Burton
authors.forename: A
authors.initials: A
authors.lastname: Murray
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D009915:Orbit; D010146:Pain / Q000517:prevention & control*; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D018918:Phacoemulsification; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D008012:Lidocaine; D002045:Bupivacaine