P. Virtanen et T. Huha, Pain in scleral pocket incision cataract surgery using topical and peribulbar anesthesia, J CAT REF S, 24(12), 1998, pp. 1609-1613
Purpose: To evaluate the pain produced during different phases of phacoemul
sification cataract surgery using a scleral pocket incision under topical v
ersus peribulbar anesthesia.
Setting: Department of Ophthalmology, Oulu University Hospital, Oulu, Finla
nd.
Methods: This prospective study comprised 100 cataract patients who were ra
ndomly selected to have phacoemulsification with a scleral pocket incision
using either topical or peribulbar anesthesia. Topical anesthesia comprised
oxybuprocaine 0.4% drops. Peribulbar anesthesia was given with an inferola
teral transconjuctival injection of an even mixture of lidocaine 2% and bup
ivacaine 0.5% with hyaluronidase. Inadvertent eye movement during surgery w
as recorded. Pain occurring during intravenous line cannulation, introducti
on of the anesthestic agent, and phacoemulsification was measured using a v
isual analog scale (from 0 to 10) and a descriptive verbal 5-step scale. Pa
tients were asked about pain immediately after each phase.
Results: The pain during cannulation was similar in both groups (P =.498).
The peribulbar injection was statistically significantly more painful than
induction of topical anesthesia (2.11 and 0.10, respectively; P <.001). Sur
gery was statistically significantly more painful in the topical group than
in the peribulbar group (2.76 and 0.85, respectively; P <.001). The mean p
ain score during all 3 phases was similar (1.43 topical group and 1.51 peri
bulbar group; P =.500). On the verbal scale, surgery was more painful under
topical than under peribulbar anesthesia (P<.001). There were no statistic
al differences in pain during the peribulbar injection and during cannulati
on (P =.461 and P =.462, respectively). Inadvertent eye movement occurred m
ore often in the topical anesthesia group.
Conclusion: Considering the entire procedure, total pain using topical anes
thesia was acceptable and equal to that using peribulbar anesthesia for pha
coemulsification with a scleral pocket incision. Pain during phacoemulsific
ation was greater under topical anesthesia but not significantly different
from the pain during the peribulbar injection.