Sub-tenon anesthesia in the operation of cataract using phacoemulsification technique

Abstract

Already in 1884, Knapp reported a successful cataract operation using 5% of cocaine in eyedrops.Today, different methods of local anaesthesia in the operation of cataract are used, such as retrobulbary, peribulbary, subconjunctival, sub-tenon, topical and intracameral anaesthesia. Phacoemulsification is a modern approach to the operation of cataract that is increasingly applied in our country. Aiming to eliminate the risk of severe complications caused by retrobulbary anaesthesia, in our patients undergoing surgery to treat cataract we applied sub-tenon anaesthesia. The aim of this work was to establish the efficacy and the safety of subtenal anaesthesia in the operation of cataract using phacoemulsification technique. We examined 85 patients who were operated for cataract under sub-tenon anaesthesia. The operation was performed using phacoemulsification technique. The surgeon injected about 2 ml of the mixture of lidocaine (2%) and bupivacaine (0.5%) in equal proportions into the bottom of the fornix at 11 o'clock or 1 o'clock position into one of the two upper eye quadrants. After phacoemulsification and the placement of intraocular lenses, the patients were asked to reply to the questions according to a standardized protocol. Priory, the patients were informed about the test and the pain scale ranging from 1 to 10, with 1 indicating the absence of pain and 10 unbearable pain. Eighty-five patients underwent surgery for cataract using phacoemulsification technique and in whom posterior chamber intraocular lenses were placed under sub-tenon anaesthesia. During the application of anaesthesia, subjective pain experience was at the level of mild discomfort or non-existent in 3/4 of the patients. In relation to pain experience during surgery, it ranged from mild inconvenience to pain absence in 4/5 of the patients. The most frequent complication during surgery was eye rolling occurring in every 10th patient. In 4/5 patients the overall surgical course was assessed by the surgeon as excellent or outstanding. Sub-tenon anaesthesia applied at one point of the upper quadrant using during modern approach in the surgery of cataract, namely the phacoemulsification technique, offers good comfort to the patient during anaesthesia introduction, as well as during surgery, with a relatively low complication rate occurring during the operation, and also offering good comfort to the surgeon.