A Prospective Evaluation of Anxiety and Pain with Topical Analgesia or Retrobulbar Anaesthesia for Small Incision Cataract Surgery

Objective: Comparing pre/per/postoperative pain and anxiety in cataract patients operated in either retrobulbar (RBA) or topical anaesthesia (TA). Study Design: Patients with uncomplicated bilateral small incision cataract surgery at short intervals were allocated to either TA or RBA and followed prospectively. Setting: Eye Department, Hjørring Hospital, Denmark. Patients: Sixteen patients or 32 eyes were operated, with 6 having TA first and 10 RBA first. Main Outcome Measures: Pre/per and postoperative pain and anxiety were evaluated using verbal descriptive as well as visual analogue scoring, and the patient's reason for preferring one anaesthetic method to the other were registrated. RESULTS: Ten patients preferred TA, 1 RBA and 5 had no preference. TA was rated 4 times less painful for the whole procedure than RBA with comparative scoring made after both eyes had been operated. The reasons for preferring TA were immediate vision (9), no patch (6), no periocular injection (5) and less pain (3). Most pain was estimated in the preoperative and postoperative periods with 4 times more pain estimated in the RBA than in the TA group, whereas no difference was estimated during surgery. The TA/RBA ratios of ‘no pain’ were preop: 16/7; perop: 13/14; postop: 14/11. Anxiety was most pronounced in the preoperative period with RBA (4 times), peroperatively with TA (twice), and with no difference between the 2 anaesthetic groups postoperatively. The TA/RBA ratios of ‘no anxiety’ were preop: 13/9; perop: 11/11; postop: 13/15. The TA/RBA ratios of sedation were preop (perorally): 11/8 and perop (intraveneously): 1/0. Analgesics were not needed in any of the anaesthetic groups during the first 24 h. Conclusions: TA is made possible by the use of modern small incision cataract surgical technique and was introduced to reduce the risks of periocular injections with current local anaesthetic techniques. TA is, as shown in this study, also preferred by the patients as it results in less pain and anxiety, especially by eliminating the need for a periocular injection, and due to the immediate visual recovery.