Rand-Stein analgesia protocol for cataract surgery

Objective: To describe the safety and efficacy of an analgesia protocol tha t enables the surgeon to maintain control over an alert patient experiencin g seemingly painless ambulatory cataract surgery, while eliminating the ris ks and side effects associated with general, local, topical, and intracamer al anesthesia. Design: Noncomparative, interventional case series. Participants: Five thousand one hundred sixty-eight consecutive cataract su rgery cases operated on by the same surgeon from April 1, 1993 through June 1, 1998. Methods: This technique produces profound ocular analgesia, avoiding any un desired sedative effects, using very low-dose, titrated, intravenous alfent anil. Complete control of the uncooperative patient, including lid squeezin g and ocular and general body movements, is obtainable whenever necessary u sing very low-dose, titrated, intravenous methohexital. Main Outcome Measures: Success was defined as surgery completed in a contro lled manner without the need to convert to general, local, topical, or intr acameral anesthesia and the patient's experience being perceived as pain fr ee. Results: One hundred percent of the cases were successful without ever devi ating from the protocol. Conclusions: This analgesia protocol offers advantages for cataract surgery . It virtually eliminates the morbidity of cataract surgery associated with other anesthesia techniques while providing excellent and reliable control . It allows for an immediate postoperative recovery with instantaneous visi on restoration. These patients are generally awake, alert, and retain their protective reflexes. (C) 2000 by the American Academy of Ophthalmology.