SPONGE ANESTHESIA FOR CATARACT-SURGERY (W ITH SCLERAL TUNNEL INCISION)

Background The successful development of cataract operation and IOL im plantation in the last decade has resulted in progressive shortening o f the incision length as well as in developing safer and simpler anest hetic techniques. The purpose of the present study was to evaluate whe ther cataract surgery with scleral incision is possible using only top ical sponge anesthesia with oxybuprocaine 0.4%. This method was compar ed with retrobulbar injection. Methods 150 patients (3 groups each con sisting 50 eyes) underwent phaco with scleral incision. 1st group: oxy buprocaine sponge anesthesia. 2nd group: oxybuprocaine sponge anesthes ia combined with mild systemic analgesia (tramadol p.o.). 3rd group: r etrobulbar injection (prilocaine/etidocaine mixture). All patients rec eived medazolam premedication (Dormicum(R), 3/10 of 1 cc). Pain and di scomfort during and after operation were investigated and statisticall y analyzed. Results Neither in group 1, 2 or 3 an additional subconjun ctival injection was necessary. Pain or discomfort during operation wa s felt in 14 percent of the patients anesthetized with the oxybuprocai ne sponge but only in 6 percent of the patients additionally premedica ted with tramadol (2nd group). Also 6 percent of the patients after re trobulbar in jection felt pain during operation. Postoperatively no si gnificant differences between group 1 and 2 were obtained: 6 per cent felt pain, 30 percent had a short term foreign body sensation. After r etrobulbar injection (group 3) only 10 percent felt postoperative pain or discomfort. Conclusions Topically applied oxybuprocaine provides s ufficient anesthesia during cataract surgery with scleral incision. A combination with mild systemic analgesia (tramadol) helps to minimize pain and discomfort. Retrobulbur injection yielded only in the postope rative period significantly better analgesia. In the operating room fu ll cooperation of the patient is required. Therefore we recommend not to use sponge anesthesia in cases when communication between surgeon a nd patient is insufficient.