Comparing the effect of topical anesthesia and retrobulbar block with intravenous sedation on hemodynamic changes and satisfaction in patients undergoing cataract surgery (phaco method)

Comparing Peribulbar and Topical Anesthesia in Cataract Surgery among Patients with Cardiovascular Disease

PURPOSE

To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease.

METHODS

A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score.

RESULTS

A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04).

CONCLUSIONS

Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.

The Effect of Binaural Beat Audio on Operative Pain and Anxiety in Cataract Surgery under Topical Anaesthesia: A Randomized Controlled Trial

Background: The aim of this paper was to examine the analgesic and anxiolytic effects of binaural beat audio in patients undergoing cataract surgery under topical anaesthesia. Methods: This was a prospective, randomized controlled trial of 61 patients undergoing cataract surgery under topical anaesthesia. They were divided into two research conditions; the binaural beat audio group, and a sham-control group (ear phones with no music). Patients completed the State-Trait Anxiety Inventory questionnaire (STAI), and their blood pressure (BP) and heart rate (HR) were measured pre- and post-intervention. Intraoperative pain levels were ascertained using a visual analog scale (VAS) completed immediately after the surgery. Results: The binaural beat group had significantly lower pain scores (p < 0.001), HR (p < 0.001), diastolic BP (p = 0.003), mean arterial pressure (p = 0.007) and anxiety (p = 0.009) than the control group. Within the binaural beat group, subjects experienced a statistically significant reduction in HR (p = 0.004) and anxiety (p < 0.001) levels compared to baseline values, while all parameters, except anxiety, increased significantly in the control group. Conclusions: Binaural beat audio decreases operative pain and anxiety in cataract surgery under topical anaesthesia. It may have additional benefits in modulating the tachycardic response to stress.

A Comparison of Retrobulbar Versus Topical Anesthesia in Trabeculectomy and Aqueous Shunt Surgery

PURPOSE

The purpose of this study was to compare the required supplemental anesthesia and postoperative patient pain score in individuals undergoing glaucoma surgery under topical anesthesia (TA) versus retrobulbar anesthesia (RB).

MATERIALS AND METHODS

A retrospective, interventional, comparative cohort study of 261 eyes of 225 patients undergoing glaucoma and combined glaucoma with cataract surgery were included in the study. The main outcome measures were the amount of supplemental, systemic intraoperative anesthesia used and the postoperative pain scale between patients undergoing TA versus RB anesthesia. A secondary analysis was performed between combined glaucoma and cataract surgery versus glaucoma surgery alone.

RESULTS

About 6.2% patients complained of pain after glaucoma surgery (8.1% among TA group and 3.1% among RB group; P=0.049). Overall, pain tended to be mild with a mean score of 0.32 of 10 for TA and 0.08 of 10 for RB (P=0.027). The amount of IV anesthetics used intraoperatively was lower in the RB anesthesia compared with the TA group (midazolam, P=0.042; fentanyl, P<0.001; propofol, P<0.001). In addition, patients undergoing RB anesthesia were less likely to use postoperative pain medication (P<0.001). There was no difference in pain score (P=0.707) or in the amount of IV anesthetics (all P>0.350) between eyes undergoing combined versus glaucoma surgery alone.

CONCLUSIONS

Although supplemental anesthesia and pain scores were statistically increased in the topical group, the prevalence and the severity of pain was low. Therefore, TA is feasible and a reasonable option for glaucoma surgery. Furthermore, this conclusion applies when glaucoma surgery is performed alone or in combination with the other eye surgery.

Effect of Local Anesthesia and General Anesthesia Using I-gel Laryngeal Mask Airway in Diabetic Patients Undergoing Cataract Surgery: Comparative Study

Background

Cataract surgery is one of the most commonly performed ophthalmic procedures. On choosing the appropriate method of anesthesia for diabetic patients with cataract whether regional or general, one should consider a technique that is associated with less stress response, minimal effect on hemodynamic and essentially associated with a good intraoperative glycemic control. This is yet to be determined.

Aims

The aim of this study is to evaluate the use of I-gel as an alternative to local anesthesia (LA) in diabetic patients undergoing cataract surgery.

Patients and Methods

This study was conducted on 60 controlled insulin-dependent diabetic patients undergoing cataract surgery. They were randomized to receive either LA by sub-Tenon's block (LA group n = 30) or general anesthesia (GA) using I-gel (GA group n = 30). Mean arterial blood pressure (MBP) and heart rate were monitored. Furthermore, blood glucose level and plasma cortisol level were measured at basal level, after induction of anesthesia or local block, after nuclear extraction, at the end of surgery, and 30, 60, 120, and 240 min postoperative.

Results

There was no significant difference in either blood glucose or cortisol levels in both groups. Blood glucose level increased with induction of anesthesia in both groups. The use of I-gel was not associated with increase heart rate or MBP compared to the LA group.

Conclusion

Both local and GA using I-gel are relatively safe without marked changes in hemodynamics, blood glucose, or cortisol level in insulin-dependent diabetic patients.

Crossover clinical trial of pain relief in cataract surgery

Purpose

To determine the effects of intra-operative Korean traditional music on pain experienced by Korean patients undergoing sequential bilateral cataract surgery.

Methods

This was a two-sequence, two-period, and two-treatment crossover study. Fifty-two patients with cataracts were divided into two groups by block randomization, and bilateral cataract surgery was performed. In group 1, patients listened to Korean traditional music (KTM) during their first but not second cataract surgery. This sequence was reversed for patients in group 2. After each surgery, patients scored their pain intensity (PI) using a visual analog scale (VAS) ranging from 0 to 10, where 0 was ‘no pain’ and 10 was ‘unbearable pain.’

Result

There was a statistically significant reduction in the mean VAS score with KTM (3.1 ± 2.0) compared to that without KTM (4.1 ± 2.2; p = 0.013). However, there were no statistically significant differences in blood pressure or pulse rates.

Conclusion

KTM had a significant effect on reducing pain experienced by patients during cataract surgery. This may be useful in the context of other surgical procedures to reduce pain in Korean patients.

Endotracheal Intubation in a Down Syndrome Adult Undergoing Cataract Surgery - a Multidisciplinary Approach

The present case report aims to describe and discuss the approach for the management of difficult endotracheal intubation in an adult with Down syndrome undergoing cataract surgery. A 26-year-old female with Down syndrome and a validated diagnosis of cataract requiring surgery was examined in order to assess the degree of difficulty of endotracheal intubation. Patients with Down syndrome have characteristic craniofacial abnormalities which require a thorough pre-operative assessment to anticipate and prepare for a difficult endotracheal intubation. Before the surgery, a series of clinical and paraclinical examinations were conducted. Although cataract surgery generally requires loco-regional anesthesia, in our case it was performed under general anesthesia. Indicators of potentially difficult intubation were macroglossia, prognathism, short neck, limited degree of head extension and obesity. The pre-operative examinations, which revealed a high degree of endotracheal intubation, allowed the anesthetist to achieve a better peri- and intra-operative management of the patient.