EVALUATION OF ANXIOLYSIS AND PAIN ASSOCIATED WITH COMBINED PERIBULBARAND RETROBULBAR EYE BLOCK FOR CATARACT-SURGERY

Study Objectives: To evaluate five different in preoperative anxiolyti c regimens in cataract surgery performed under regional anesthesia; to quantify the pain associated with combined peri-and retrobulbar injec tion (PRBI) of local anesthetic drugs; and to describe a technique of painless eye block. Design: Randomized, double blind, placebo-controll ed study. Setting: Private clinic. Patients: 376 ASA I and II patients presenting for cataract surgery. Interventions: Patients were extensi vely briefed by the nursing staff on the various procedures. Of the 37 6 study patients, 136 preferred to have no anxiolytic drug The remaini ng 240 patients were randomly allocated to one of six groups to receiv e either 3 mg of bromazepam 6 mg of bromazepam, 0.5 mg of alprazolam, 1 mg of alprazolam, 5 mg of diazepam, or a placebo on a double-blind p rotocol. All patients received a standard combined peri- and retobulba r eye block (PRBB) before surgery. Measurements and Main Results: Anxi ety at various stages of the procedure and PRBB were measured on visua l analog scale (0-10). PRBB pain was compared with pain Of intravenous (IV) cannula placement. On admission, anxiety of the 136 patients who preferred no anxiolytic premedication was significantly less than tha t of the 240 patients assigned to one of the six treatment groups (p < 0.05). There was no difference between the six treatment groups in rep orted anxiety before surgery (p >0.05) except for Group I (3 mg bromaz epam), where anxiety increased before and during PRBB administration ( p <0.05). In all six treatment groups, anxiety decreased significantly 30 minutes after medication was administered (p <0.05). For the total group, 61.18% of patients reported more or equal pain associated with the placement of the 20-gauge IV cannula than by the PRBB. Of the pat ients who received medication, 94% stated that, should they require an other eye operation, they would like the same anxiolytic treatment. No patient requested general anesthesia for their next operation or to b e rendered unconscious for PRBB. Conclusions: 1. There was interperson al variation in the level of preoperative anxiety. 2. In patients who were anxious, the anxiolytic drugs and placebo decreased anxiety altho ugh the level of anxiety did not differ between the anxiolytic drugs o r between placebo and the anxiolytic drugs. The only difference was in Group 1 patients (3 mg promazepam), who reported slightly increased a nxiety before and during PRBB administration (p < 0.05). 3. Placement of the PRBB is less painful than the insertion of a 20 g IV cannula. ( C) 1998 by Elsevier Science Inc.