Intravenous versus Non-intravenous Sedation for Cataract Surgery: A Systematic Review and Meta Analysis.

Topic: This review assesses the effectiveness of intravenous sedation compared to non-intravenous sedation for routine cataract surgery.

Clinical relevance: Cataract surgery is a safe and routinely performed surgery. Sedation practices vary, with centers providing either intravenous (IV), oral or no sedation for surgery. Improving sedation practices may have significant implications for patient safety, patient experience and health system efficiency.

Methods: Medline, Embase, Cochrane Library, BIOSIS, Web of Science, and CINAHL were searched from inception to July 2024 for relevant articles containing original data. Randomized controlled trials that compared IV to oral or no sedation and 1) used a validated pain scale to report on pain or 2) reported on perioperative complications were included. A random effects meta-analysis was conducted. Odds ratios, standard mean differences, 95% confidence intervals (CIs), and I2 statistics were reported. The review was registered in PROSPERO (CRD42024582495) and PRISMA guidelines were followed.

Results: 12 randomized controlled trials including 1130 patients were included in the meta-analysis. IV sedation was associated with significantly decreased pain compared to no sedation (SMD = -0.98, 95% CI -1.68 to -0.29). Comparing IV and oral sedation, however, there was no difference in patient reported pain (SMD = -0.54, 95% CI -1.60 to 0.52). Analysis of intraoperative complications showed that there was no significant difference in complications between patients receiving IV and oral sedation (OR = 0.68, 95% CI 0.27 to 1.73).

Conclusion: For routine cataract surgery, IV sedation was associated with less pain than no sedation, but oral and IV sedation provided comparable pain control. Perioperative complications occur at similar rates regardless of sedation modality. These findings may help to inform sedation practices for cataract surgery.