Patient’s pain perception and surgeon satisfaction with topical anaesthsia in phacoemulsification surgery

As the cataract surgery has taken the quantum leaps, so does the advancements in various anaesthetic techniques, aiming to provide a safer, painless and comfortable surgery. Topical anaesthesia is a less invasive anaesthetic option which provides adequate analgesia with wide margin of safety. We aimed to evaluate the efficacy of topical anaesthesia as a routine in a standard phacoemulsification surgery. A total of200 patients scheduled for routine phacoemulsification were enrolled in a prospective, non-randomized comparative clinical study. Patients were then distributed to either topical anaesthesia group (TA) or peribulbar anaesthesia group (PA) to evaluate for patient and surgeon satisfaction, and intraoperative complications. The study groups were comparable demographically. Pain scores were higher during late stages of surgery in TA (p<0.01), while higher scores were noticeable in PA (p<0.01) during administration and in the postoperative periods. Significantly higher rate of chemosis was seen in PA (p<0.01). The patients in the TA had an overall better surgical experience as compared to the PA (p<0.01).Though surgeon does note higher per-operative pain perception (p=0.027) and ocular motility (p<0.01) in the TA there was no significant difference as far as ease of surgery was concerned. Despite higher per-operative pain perception most of the patients describe their surgical experience with topical anaesthesia as satisfactory. In view of its minimally invasive nature, topical anaesthesia is a safer alternative to peribulbar anaesthesia practically avoiding all block related complications especially in at risk eyes, and thus can be safely administered as a routine in phacoemulsification surgery.