Topical versus sub-Tenon's anesthesia without sedation in cataract surgery

Purpose: To compare pain control using topical anesthesia with that using s ub-Tenon's anesthesia for clear corneal phacoemulsification cataract surger y and foldable intraocular lens (IOL) implantation. Setting: Departments of Ophthalmology, General Hospital Asklepeion Voulas a nd General Hospital of Athens, University of Athens, Athens, Greece. Methods: One hundred consecutive patients scheduled for bilateral cataract surgery Ito 2 months apart were prospectively randomized to receive topical anesthesia (100 eyes)or sub-Tenon's anesthesia (100 eyes). The randomizati on was stratified so that one half of first-eye surgeries and one half of s econd-eye surgeries were assigned to each anesthesia group, with each patie nt receiving each type of anesthesia once. All patients had clear corneal p hacoemulsification with foldable IOL implantation, Patients were asked to r ate their pain level on a 10-point scale for 4 periods: during the administ ration of the anesthetic agent, during surgery, immediately after surgery, and 24 hours postoperatively. The surgeon recorded his subjective assessmen t of ease of surgery and surgical complications using a standardized templa te. Results: Eighty-one percent of patients who received topical anesthesia and 8% of patients who received sub-Tenon's anesthesia reported no pain during delivery of the anesthetic agent. The mean pain score was 0.19 +/- 0.39 (S D) in the topical group and 1.35 + 0.63 in the sub-Tenon's group. The diffe rence between groups was statistically significant (P <.001). Seventy-two p ercent of patients in the topical anesthesia group and 86% in the sub-Tenon 's anesthesia group reported no pain or slight discomfort during surgery (m ean score 1.13 <plus/minus> 1.57 and 0.57 +/- 1.28, respectively) (P <.001) . Ninety percent of topical anesthesia patients and 100% of sub-Tenon's ane sthesia patients reported no pain or slight discomfort 30 minutes postopera tively (mean score 0.80 <plus/minus> 0.93 and 0.12 +/- 036, respectively) ( P <.001). All patients in the topical anesthesia group and 77% in the sub-T enon's group reported no pain 24 hours postoperatively (mean pain 0.00 <plu s/minus> 0.00 and 0.23 +/- 0.40, respectively) (P <.001). Complications inc luding prolonged akinesia of the globe, chemosis, and conjunctival hemorrha ge occurred significantly more frequently in the sub-Tenon's than in the to pical group (P <.001), Conclusions: Patients having cataract surgery under topical anesthesia had more intraoperative and postoperative discomfort than patients receiving su b-Tenon's anesthesia. However, patients having topical anesthesia reported less pain during its j administration and had fewer complications. Both ane sthesia methods provided high levels of pain control without additional sed ation. J Cataract Refract Surg: 2001; 27: 873-879 (C) 2001 ASCRS and ESCRS.