Effectiveness of sub-Tenon's versus peribulbar anesthesia in extracapsularcataract surgery

Purpose: To compare the effectiveness of sub-Tenon's versus peribulbar anes thesia in extracapsular cataract surgery. Setting: Department of Ophthalmology and the Maccabi Eye Institute, Tel Avi v, Israel. Methods: Sixty-four consecutive patients who had extracapsular cataract sur gery were randomized to have sub-Tenon's or peribulbar anesthesia. Intraocu lar pressure (IOP) was measured before 1 and 10 minutes after injection. Th e motility of the rectus muscles was evaluated before and 20 minutes after the injection, and the patients's anxiety level was recorded immediately af ter the injection. Pain was assessed intraoperatively and 1 and 24 hours po stoperatively by patient self-grading. Results: One minute after the injection, IOP increased significantly in the peribulbar group (mean 7.97 mm Hg +/- 8.80 [SD]) (P < .05). There was no s ignificant increase in the sub-Tenon's injection group (mean 0.12 +/- 3.09 mm Hg). In both groups, IOP returned to preinjection levels by 10 minutes p ostoperatively. Patients with peribulbar anethesia reported a significantly higher level of anxiety than those who had sub-Tenon's anesthesia (P < .05 ). Although the intraoperative pain levels were the same, the sub-Tenon's g roup reported significantly higher levels of pain 1 and 24 hours postoperat ively; 16% in the sub-Tenon's group and none in the peribulbar group report ed moderate pain 24 hours after anesthesia. Ocular motility was the same ex cept for the inferior rectus muscle, which was less motile on average in th e peribulbar group. Conclusion: Sub-Tenon's anesthesia led to less IOP elevation than peribulba r anesthesia and provided similarly good globe immobilization and approxima tely the same pain levels intraoperatively. J Cataract Refract Surg 1999; 2 5:1646-1650 (C) 1999 ASCRS and ESCRS.