title: Comparison of sedation requirements for cataract surgery under topical anesthesia or retrobulbar block.
abstract: OBJECTIVE
  Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia.
  
  
  METHODS
  In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 microg) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display.
  
  
  RESULTS
  Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94+/-0.92 in the topical group and 2.92+/-0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05).
  
  
  CONCLUSIONS
  Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia.
authors.affiliation: Department of Anaesthesiology, Dokuz Eylül University Medical School, Izmir - Turkey. bkuvaki@deu.edu.tr
authors.forename: B Kuvaki
authors.initials: BK
authors.lastname: Balkan
authors.forename: L
authors.initials: L
authors.lastname: Iyilikçi
authors.forename: F
authors.initials: F
authors.lastname: Günenç
authors.forename: H
authors.initials: H
authors.lastname: Uzümlü
authors.forename: H C
authors.initials: HC
authors.lastname: Kara
authors.forename: L
authors.initials: L
authors.lastname: Celik
authors.forename: I
authors.initials: I
authors.lastname: Durak
authors.forename: E
authors.initials: E
authors.lastname: Gökel
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007322:Instillation, Drug; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008874:Midazolam; D005283:Fentanyl