Patient comfort during clear corneal phacoemulsification with sub-Tenon's local anesthesia.
OBJECTIVE
To assess patient comfort with and without intravenous (i.v.) cannulation during 1-quadrant sub-Tenon's anesthesia during phacoemulsification.


METHODS
Royal Alexandra Hospital, Paisley, Scotland, United Kingdom.


METHODS
This prospective masked controlled clinical trial comprised 119 patients having elective clear corneal phacoemulsification. Fifty had sub-Tenon's anesthesia with an i.v. cannula; 23, sub-Tenon's anesthesia without an i.v. cannula; and 46, topical anesthesia of proparacaine 0.5% without an i.v. cannula. No patient received sedation. All patients had clear corneal phacoemulsification with foldable posterior chamber intraocular lens implantation. The patients' subjective pain experience was measured immediately after surgery by a single independent observer using a 10-point visual analog scale.


RESULTS
The mean patient-reported pain was low in all 3 groups. The mean i.v. cannula-related pain score in the sub-Tenon's group with an i.v. cannula (1.00; range 0 to 8) was higher than the mean general pain score (0.46; range 0 to 5) and worst pain experienced during surgery score (0.64; range 0 to 3). In the topical anesthesia group, 8 patients (17%) reported greater discomfort directly or indirectly related to the subconjunctival antibiotic injection at the end of surgery.


CONCLUSIONS
Patient-reported pain caused by placing an i.v. cannula in the sub-Tenon's group significantly altered overall patient comfort during the surgical experience. Thus, the routine use of i.v. access during clear corneal phacoemulsification under sub-Tenon's anesthesia should be avoided to improve patient satisfaction.
Mathew
Manu R K
MR
Department of Ophthalmology, Royal Alexandra Hospital, Argyll and Clyde Acute Hospitals NHS Trust, Renfrewshire, Scotland, United Kingdom. prabha@tesco.net
Williams
Anne
A
Esakowitz
Leonard
L
Webb
Lennox A
LA
Murray
Stephen B
SB
Bennett
Harry G B
HG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002404:Catheterization / Q000379:methods; D003238:Connective Tissue; D003315:Cornea / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies
D000779:Anesthetics, Local