Abstract
PurposeTo assess safety and efficacy of deep topical anesthesia with ropivacaine-soaked sponge compared with topical anesthesia with oxybuprocaine in patients undergoing phacoemulsification.MethodsThis was a retrospective study where records of patients operated for cataract were evaluated. Patients using a visual analogue scale scored pain during surgery, and the surgeon on a questionnaire recorded ease of operation. Medical records were evaluated for patients who received topical anesthesia with multiple administrations of oxybuprocaine 0.4% or those who received deep topical anesthesia with a polyvinyl acetal sponge impregnated with ropivacaine 0.75% and positioned under the eyelid 30 min before surgery.ResultsA total of one hundred patient records, equally divided in patients receiving deep topical anesthesia or topical anesthesia, were included. The visual analogue scale scores among the groups were statistically significant for a lower pain score in patients who received deep topical anesthesia with ropivacaine-soaked sponges (p = 0.0069). The average surgeon score was significantly higher for the deep topical anesthesia group indicating favorable ease of surgery (p = 0.0341). Six patients had major complications during surgery. No additional anesthesia was necessary to manage the complications in four patients in the deep anesthesia group, whereas propofol was used for the induction and maintenance of anesthesia in two patients in the topical anesthesia group.ConclusionsDeep topical anesthesia with ropivacaine-soaked sponges performed as well as topical oxybuprocaine regarding safety and efficacy. It provided a lower patient pain score, favorable surgeon satisfaction, and long-lasting anesthesia.
Highlights
The goals of any type of anesthesia in ophthalmic surgery are to provide pain free surgery, minimize risks of systemic complications, facilitate surgical procedure, and reduce risk of surgical complications
Subtenon anesthesia has reduced the risk of complications of general anesthesia, but the technique is still associated with a possibility of complications of peribulbar/retrobulbar techniques [1, 2]
We evaluated and compared the efficacy and safety of a ropivacaine-soaked sponge placed deep in the inferior fornix versus multiple topical drops of oxybuprocaine 0.4% in patients undergoing cataract surgery with phacoemulsification
Summary
Records of patients who underwent phacoemulsification for age-related cataract at the ophthalmology unit of the Sant’Andrea Hospital, ‘‘Sapienza’’ University of Rome, were evaluated over a 12-month period from 2016 to 2017. In 2016, the surgeon used traditional topical anesthesia with one drop of topical oxybuprocaine 0.4% every 5 min for 4 times in the fornix for surgery. In 2017, all the operations were carried out with deep topical anesthesia where 30 min before. Following surgery, the surgeon completed a modified questionnaire, originally conceived by Gupta et al [22], which consisted of three items to evaluate patient cooperation, unwanted ocular movements, and anterior chamber stability. The statistical difference between the VAS scores among the groups was significant (p = 0.0069) with a lower score for deep topical anesthesia indicating less reported pain during surgery. Statistical analysis showed a significant difference between the two groups (p = 0.0341) with a higher surgeon score for deep topical anesthesia, implying better surgeon satisfaction. Three eyes received hypotensive treatment on the first postoperative day; two were treated with topical apraclonidine 0.5% and one received oral acetazolamide [24, 25]
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