Lidocaine-assisted xylocaine jelly anesthesia versus one quadrant sub-Tenon infiltration for self-sealing sclerocorneal incision routine phacoemulsification.
OBJECTIVE
To compare the effect of xylocaine jelly and intracameral lidocaine with one quadrant instant sub-Tenon infiltration for self-sealing sclerocorneal phacoemulsification.


METHODS
One hundred patients were enrolled into a prospective randomized study, receiving either a combination of topical 2% xylocaine jelly and 0.5 ml of intracameral 1% lidocaine or sub-Tenon infiltration with 2 ml of 2% xylocaine on the operating table. All patients underwent a standard divide and conquer phacoemulsification procedure through a superior sclerocorneal frown incision followed by implantation of a polymethylmethacrylate intraocular lens. Intraoperative pain was indicated by the patient by squeezing the bedside nurse's hand, who allocated it to particular stages of surgery on a chart. After surgery, patients assessed the pain experienced using a 10-unit visual analogue scale.


RESULTS
Pain was indicated on 31 occasions during the operation in the sub-Tenon group (mainly the injection itself) and 67 times in the topical group. The median overall subjective pain score was 3 in the jelly group and 0 in the sub-Tenon. Five eyes (10%) had to be converted to sub-Tenon during the surgery because of intolerable pain.


CONCLUSIONS
Whereas lidocaine supported xylocaine jelly anesthesia provided acceptable analgesia for 90% of patients operated, sub-Tenon anesthesia proved to deliver better intraoperative comfort in all patients receiving sclerocorneal incision cataract surgery.
Sekundo
W
W
Department of Ophthalmology, Philipps University, Marburg, Germany. sekundo@med.uni-marburg.de
Dick
H B
HB
Schmidt
J C
JC
D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003315:Cornea / Q000601:surgery; D005260:Female; D005782:Gels; D006801:Humans; D007267:Injections; D007430:Intraoperative Care / Q000379:methods; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D010147:Pain Measurement / Q000379:methods; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies
D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine