LOCAL-ANESTHESIA FOR ADULT CATARACT-SURGE RY - A RETROSPECTIVE STUDY OF PERIBULBAR ANESTHESIA, SUBCONJUNCTIVAL ANESTHESIA AND TOPICAL ANESTHESIA

Purpose A retrospective analysis of 4 methods of local anaesthesia for adult cataract surgery compares the efficiency of : peribulbar anaest hesia injection, subconjonctival anaesthesia injection, both of these techniques and eye topical anaesthesia. No sedation is used. All patie nts are classified in ASAI or ASA II grade of the anesthesiologist cla ssification. All the surgeries are performed in an out patient center. The anaesthetic solution combines equallyt bupivacaine 0.5 %, lidocai ne 2 % and hyaluronidase 250 UI. Phacoemulsification is performed thro ugh a scleral small incision. Methods 390 patients are separated in 4 groups. Analgesia and Akinesia are evaluated in 3 levels : total, part ial and absent. Results They show that a single peribulbar injection l ess of 8 ml is sufficient in 86.5 % of cases. In case of a unique subc onjonctival injection 2 ml are used with a rate of full success of 67. 8 %. When combinating these 2 methods the surgery is easily possible i n 97.9 % of cases. A complementary subconjonctival injection is necess ary in 4.9 % of eyes receiving only the inferior peribulbar infiltrati on and in 13% of eye anaesthezied by the single subconjonctival inject ion. 20.3 % of eyes receiving only topical anaesthesia need a compleme ntary subconjonctival injection during surgery. But the study covers t he first series of patients operated with this new method, most of the se cases are men. Results are better with experience, confidence and c orneal incision. Conclusion Local anaesthesia is a safe procedure offe ring very few local and general risks. General sedation or premedicati on is not necessary. The choice depends on the akinesia factor which i s far more difficult to obtain with so few anaesthetic volumes than th e analgesia.