Contact-topical plus intracameral lidocaine versus peribulbar anesthesia in combined surgery: a randomized clinical trial.
OBJECTIVE
To compare the efficiency and safety of contact-topical anesthesia versus peribulbar injection anesthesia for phacotrabeculectomy.


METHODS
A total of 80 patients undergoing combined cataract and glaucoma surgery were randomly allocated to receive either contact or peribulbar anesthesia. No systemic sedatives were used in either group. Patients were asked to rate their pain level on a 5-point scale for 4 periods: during administration of the anesthetic agent; during surgery; immediately after surgery; and 24 hours postoperatively, while the surgeon recorded his subjective assessment of ease of surgery using a standardized template. The patients' general condition during surgery, as well as the results and short-term complications, were assessed.


RESULTS
The injected anesthesia group showed higher rates of discomfort and pain, and 37 patients reported pain ranging from mild to severe during anesthetic administration. The difference between groups was statistically significant (P < 0.001). During surgery, there were no differences in vital signs, patients' subjective pain evaluation, or surgeon stress. We found no differences between pain rates after surgery. Complications included prolonged chemosis, and we also noted that conjunctival hemorrhage occurred more frequently in the peribulbar group than in the contact anesthesia group.


CONCLUSIONS
Both anesthetic methods provide high levels of pain control without additional sedation during surgery. The use of contact-topical anesthesia avoids pain and reduces the possibility of complications during administration of anesthetics.
Pablo
Luis E
LE
Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain. lpablo@posta.unizar.es
Ferreras
Antonio
A
Pérez-Oliván
Susana
S
Larrosa
José Manuel
JM
Gómez
Maria Luisa
ML
Honrubia
Francisco M
FM
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002387:Cataract Extraction / Q000009:adverse effects; D005123:Eye; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007267:Injections / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D018918:Phacoemulsification / Q000009:adverse effects; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome
D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008012:Lidocaine; D002045:Bupivacaine