Topical anesthesia versus retrobulbar block for cataract surgery: The patients' perspective

Study Objectives: To compare patients' perceptions of topical anesthesia (T A) with combined peribulbar ans retrobulbar block (PRBB) for cataract surge ry. Design: Prospective, randomized, controlled, cross-over observational study . Setting: Private clinic. Patients: 98 ASA physical status I and II patients presenting for bilateral cataract surgery 1 week apart. Interventions: Patients were prospectively randomized to receive either TA for surgery to one eye, followed by PRBB for surgery to the other eye 1 wee k later, or to receive PRBB, and TA were followed by TA for the second oper ation the following week. Surgery, PRBB, and TA were standard for all cases . Interviews were conducted the day following surgery by an unbiased observ er unaware of the technique used. Surgical pain was estimated on a visual a nalog scalp of 0 to 10, and the surgeon judged the difficulty of surgery ba sed on patient compliance and cooperation on a scale of 0 to 5. Means and v ariance of results were compared with analysis of variance. Measurements and Main Results: Mean age was 71.45 +/- 9.76 years (mean +/- SD). Seventy patients (71.43%) preferred PRBB while 10 patients (10.20%) pr eferred TA (p = 0.0001). Eighteen patients (18.37%) reported no difference between the two techniques. Ninety-six patients (97.96%) were not aware of the PRBB being injected. Duration of surgery was similar for TA (11.92 +/- 3.43 min) and PRBB (10.78 +/- 3.00 min; p = 0.06). Surgery was more difficu lt during TA (p = 0.0004). Pain was worse during TA (p = 0.0001). Surgical and anaesthetic complications were unremarkable for both techniques. Conclusions: Patients who experienced both TA and PRBB preferred PRBB. (C) 2000 by Elsevier Science Inc.