Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery – A Comparative Study from Hyderabad Karnataka Region

Abstract

BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia