Synthesis of the literature on the effectiveness of regional anesthesia for cataract surgery

Objective: To synthesize the findings of the randomized trials of regional anesthesia management strategies for cataract surgery, Design: Literature review and analysis. Method: The authors performed a systematic search of the literature to iden tify all articles pertaining to regional anesthesia during cataract surgery on adults. One investigator abstracted the content of each article onto a custom-designed form. A second investigator corroborated the findings. The evidence supporting the anesthesia approaches was graded by consensus as go od, fair, poor, or insufficient. Main Outcome Measures: Evidence supporting the effectiveness of different f orms of regional anesthesia. Results: There was good evidence that retrobulbar and peribulbar blocks pro vide equivalent akinesia and pain control during cataract surgery. Addition ally, sub-Tenon's blocks were at least as effective as retrobulbar and peri bulbar blocks. There was good evidence that retrobulbar block provides bett er pain control during surgery than topical anesthesia, and there was fair evidence that peribulbar block provides better pain control than topical an esthesia, Conclusions: This synthesis of the literature demonstrates that currently u sed approaches to anesthesia management provide adequate pain control for s uccessful cataract surgery, but there is some variation in the effectivenes s of the most commonly used techniques. Data are needed on patient preferen ces to determine the optimal strategies for anesthesia management during ca taract surgery. (C) 2001 by the American Academy of Ophthalmology.