Jennifer Kim MD
Topical anaesthesia is a safe and effective alternative to sub-Tenon’s block anaesthesia and results in equally high patient satisfaction without the risk of serious complications associated with sub-Tenon’s use in cataract surgery, according to a study presented at the XXX Congress of the ESCRS.
“Our study highlights the importance of a thorough preoperative assessment to select which patients will best tolerate the topical anaesthesia. The effect of topical anaesthesia delivered by an experienced surgeon will lead to shorter operation time, minimal complications and excellent patient satisfaction,” Minji Jennifer Kim, told delegates.
Noting that sub-Tenon’s block is the most preferred anaesthesia for cataract surgery in the UK, Dr Kim, Barnet Hospital London, UK, said that several recent reports have described topical anaesthesia as a safe alternative for injection anaesthesia, particularly in selected patient groups.
“We wanted to test this hypothesis and compare patient satisfaction in sub-Tenon’s block and topical anaesthesia used in phacoemulsification cataract surgery. We also decided to try to identify additional factors which may affect patient satisfaction used in cataract surgery and compare postoperative pain experienced by patients using the two types of anaesthesia,” she said.
Dr Kim’s study included 56 patients who underwent phacoemulsification cataract surgery between December 2011 and March 2012. All operations were performed by two consultant ophthalmologists, one using exclusively sub-Tenon’s block and the other topical anaesthesia. Some cases were partly or fully performed by trainee surgeons under consultant supervision, said Dr Kim.
A written postoperative questionnaire was completed by patients following their surgery and patient satisfaction was measured using the modified Iowa Satisfaction with Anaesthesia Scale (ISAS). A 10-point visual analogue scale (VAS) was used as an additional measure of pain and a separate questionnaire was filed in by the operating surgeons.
Looking at the results, Dr Kim said that while there was slightly higher patient satisfaction in the sub-Tenon’s group, this was not statistically significant. The postoperative pain evaluation using the visual analogue scale also showed no statistical significance between sub-Tenon’s block and topical anaesthesia.
A significant difference was seen, however, in patient satisfaction with reduced duration of the operation and the experience of the operating surgeon. No differences were seen in variables including sex, age and previous exposure to cataract surgery.
Two cases of excessive pain experienced with topical anaesthesia necessitated conversion to local anaesthesia. In the sub-Tenon’s block group, one patient experienced severe chemosis, and one patient had incomplete akinesia which interfered with the surgery and required reinforcement of the anaesthesia.
Summing up, Dr Kim said that there was no significant difference in patient satisfaction between the groups treated using sub-Tenon’s block or topical anaesthesia.
“Patient satisfaction is, however, affected by the duration of the operation and seniority of the surgeon. We advise that complex cases performed by the senior surgeons will minimise the risk of intraoperative and anaesthesia-related complications,” she said.
