The effect of combined topical-intracameral anaesthesia on neuroleptic requirements during cataract surgery.
OBJECTIVE
To evaluate whether the addition of intracameral lidocaine to topical anaesthesia during cataract surgery leads to a decrease in the administration of intraoperative midazolam and fentanyl.


METHODS
Retrospective case-control study.


METHODS
The eyes of 124 patients undergoing phacoemulsification were included in the study, with 62 in the intracameral group and 62 in the control group.


METHODS
A single-centre, retrospective chart review of cases between April and October 2007 in which patients had undergone small-incision phacoemulsification with foldable intraocular lens insertion and received preoperatively either topical tetracaine 0.5% with unpreserved intracameral lidocaine 1% (intracameral group) or topical tetracaine 0.5% alone (control group). Intraoperatively, midazolam and fentanyl were administered as needed based on pain and anxiety.


RESULTS
A total of 124 eyes (124 patients) were included. There was no statistically significant difference between the mean intraoperative midazolam doses given for the 2 groups (p = 0.08). The mean intraoperative dose of fentanyl was lower in the intracameral than in the control group (p < 0.0001). A comparison of intraoperative fentanyl requirements between groups using a multivariate regression analysis for age, gender, surgical time, and preoperative fentanyl levels confirmed the lower need for intraoperative fentanyl in the intracameral compared with the control group (p = 0.0037). There were no anaesthetic complications among any of the study patients.


CONCLUSIONS
Patients receiving topical tetracaine 0.5% with unpreserved intracameral lidocaine 1% during cataract surgery demonstrated a reduction in intraoperative fentanyl requirements. Surgeons performing cataract surgery under topical anaesthesia should consider the addition of intracameral lidocaine 1% to decrease fentanyl requirements and improve patient safety and comfort.
University of British Columbia Medical School, Vancouver, BC, Canada.
Adelyn L
AL
Ho
Peter A
PA
Zakrzewski
Rosa
R
Braga-Mele
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D002387:Cataract Extraction / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005283:Fentanyl; D006801:Humans; D056965:Injections, Intraocular; D007430:Intraoperative Care; D008012:Lidocaine / Q000008:administration & dosage; D008874:Midazolam; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D012189:Retrospective Studies; D013748:Tetracaine / Q000008:administration & dosage
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D014150:Antipsychotic Agents; D013748:Tetracaine; D008012:Lidocaine; D008874:Midazolam; D005283:Fentanyl