Topical anesthesia versus retrobulbar block for cataract surgery: the patients' perspective.
OBJECTIVE
To compare patients' perception of topical anesthesia (TA) with combined peribulbar and retrobulbar block (PRBB) for cataract surgery.


METHODS
Prospective, randomized, controlled, cross-over observational study.


METHODS
Private clinic.


METHODS
98 ASA physical status I and II patients presenting for bilateral cataract surgery 1 week apart.


METHODS
Patients were prospectively randomized to receive either TA for surgery to one eye, followed by PRBB for surgery to the other eye 1 week later, or to receive PRBB first, followed by TA for the second operation the following week. Surgery, PRBB, and TA were standard for all cases. Interviews were conducted the day following surgery by an unbiased observer unaware of the technique used. Surgical pain was estimated on a visual analog scale of 0 to 10, and the surgeon judged the difficulty of surgery based on patient compliance and cooperation on a scale of 0 to 5. Means and variance of results were compared with analysis of variance.


RESULTS
Mean age was 71.45 +/- 9.76 years (mean +/- SD). Seventy patients (71.43%) preferred PRBB while 10 patients (10.20%) preferred TA (p = 0.0001). Eighteen patients (18.37%) reported no difference between the two techniques. Ninety-six patients (97.96%) were not aware of the PRBB being injected. Duration of surgery was similar for TA (11.92 +/- 3.43 min) and PRBB (10.78 +/- 3.00 min; p = 0.06). Surgery was more difficult during TA (p = 0.0004). Pain was worse during TA (p = 0.0001). Surgical and anaesthetic complications were unremarkable for both techniques.


CONCLUSIONS
Patients who experienced both TA and PRBB preferred PRBB.
Boezaart
A
A
MediClinic Hospital, Paarl, Western Cape, South Africa. apbzrt@iafrica.com
Berry
R
R
Nell
M
M
D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000704:Analysis of Variance; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D002387:Cataract Extraction; D016292:Procedural Sedation; D003299:Cooperative Behavior; D018592:Cross-Over Studies; D005123:Eye; D005260:Female; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D009407:Nerve Block; D009883:Ophthalmic Solutions; D010147:Pain Measurement; D010349:Patient Compliance; D017060:Patient Satisfaction; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D011446:Prospective Studies; D000077212:Ropivacaine; D016037:Single-Blind Method
D000577:Amides; D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D011343:Procaine; D000077212:Ropivacaine; D008012:Lidocaine; C005298:benoxinate