Anesthesia For Cataract Surgery Research Articles

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 19, a comparative study of the cost and carbon footprint of local anaesthesia techniques for cataract surgery.

Understanding the financial and environmental impact of clinical pathways is important for designing sustainable services. This study aimed to compare the cost and carbon footprint of sub-Tenon's and topical anaesthesia for cataract surgery, benchmark minimum topical anaesthesia utilisation rates, and quantify the benefits of increased topical anaesthesia usage in the United Kingdom National Health Service (NHS). The cost and carbon footprint of products and staffing for topical and sub-Tenon's anaesthesia for cataract surgery were calculated and applied to National Ophthalmology Database audit data. A mainly process-based approach was used to estimate the carbon dioxide equivalent (CO2e) of product production, usage, and waste disposal. The typical CO2e per case was 0.71 kg for topical anaesthesia and 1.19 kg for sub-Tenon's anaesthesia. Around a third of CO2e was generated by usage of unneccesary equiptment and wasteful practices. The typical cost per case was £14.60-£17.14 for topical anaesthesia, £27.74 for sub-Tenon's anaesthesia performed by an operating department practitioner and £56.15 for sub-Tenon's anaesthesia performed by a consultant anaesthetist. It is estimated that around 25,000 NHS cataract cases could annually be converted from sub-Tenon's to topical anaesthesia, which would reduce the CO2e emissions of services by 12,000 kg while saving £265,000 on product usage and between £63,500 and £773,750 on staffing. Topical anaesthesia is a cheaper and more environmentally sustainable alternative to sub-Tenon's anaesthesia for cataract surgery. Increased topical anaesthesia usage in cataract services could contribute towards the NHS aspiration of becoming "net zero" by 2040.

“Effectiveness of Topical Vs Retrobulbar Anesthesia in Cataract Surgery”

Introduction: Local anesthesia has become preferable to general anesthesia for cataract surgery due to improvements in techniques and instrumentation. The advantages of local anesthesia are well known and include more rapid ambulation, the ability to perform the procedure as an outpatient, avoidance of complications of general anesthesia, and quicker surgery. This study aimed to evaluate and compare the efficacy of topical and retrobulbar anesthesia for cataract surgeries. Methods: This was a retrospective observational study and was conducted in the Department of Anaesthesia, analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2022 to August, 2023. In our study, we included 60 patients who were undergoing cataract surgery. Patients were divided into two groups – Group A (Patients who received topical anesthesia) and Group B (Patients who received retrobulbar anesthesia. Result: The mean age of study patients was 73.4 ± 8.9 and 74.2 ± 7.4 in Groups A and B respectively. The mean Pain score was 0.87 ± 1.41 and 0.74 ± 1.70 in Groups A and B respectively. The most common preoperative risk factor was exfoliation syndrome (40% in group A and 30% in group B). Twenty-eight patients (93%) in the topical anesthesia group and 60% in the retrobulbar anesthesia group reported no pain at all. Conclusion: In conclusion, topical anesthetic, as opposed to retrobulbar anesthesia, offers the surgeon good surgical conditions and comfortable operating circumstances for the patient, even in challenging instances with related ocular comorbidities.

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

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

Comparison of Levobupivacaine over Lignocaine for Peribulbar Anesthesia in Cataract Surgery – A Randomized Control Study in a Tertiary Care Hospital

Abstract Introduction: Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform. Objectives: This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery. Methods: A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration. Results: In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P &lt; 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference. Conclusion: Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication.

Brainstem Anesthesia after Retrobulbar Anesthesia in Cataract Surgery: A Case Report

Brain-stem anesthesia is a serious and rare complication of orbital regional anesthesia that may occur when the local anesthetic agent gains access to the central nervous system via a direct spread from the apex of the orbit or the submeningeal pathways. We report the case of a 66 -year-old man who developed, after a retro-bulbar block for cataract surgery, a tonico-clonic seizures, hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem. Although it is rare, and because it may be life-threatening in some cases, physicians who perform retrobulbar block should be aware of its features and various clinical manifestation in order to recognize and treat it. Also, facilities where ophtalmic surgery under local anesthesia are performed should be properly equiped in order to manage this complication.

Comparison of volume-controlled and pressure-controlled ventilation during laryngeal mask airway anesthesia in cataract surgery

Introduction: Most patients undergoing eye surgery are elderly adults with underlying cardiovascular diseases. One of the complications during recovery is gastric insufflation, which can cause detrimental effects on cardiovascular patients. The present study compares two methods of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Methods: The study enrolled 81 patients undergoing cataract surgery (41 in the PCV group and 40 in the VCV group). According to the American Society of Anaesthesiologists (ASA) classes I and II received general anaesthesia and laryngeal mask airway (LMA) ventilation using VCV or PCV. Maximum pressure (Ppeak), dynamic compliance, expiratory tidal volume, Spo2, non-invasive blood pressure, heart rate, and pain in the epigastrium and umbilical region were monitored at intervals of 1, 5, 10, and 20 minutes after the initiation of anaesthesia and the results of two groups were compared. Results: The means of Ppeak and tidal volume in the PCV group as well as the means of dynamic compliance and end-tidal carbon dioxide (EtCO2) in the VCV group were significantly high. The mean diastolic blood pressure was significantly different between two groups at 20th minute. There were no significant differences in heart rate, mean systolic blood pressure, arterial oxygen saturation, or abdominal pain between two study groups. Conclusion: VCV had a lower Ppeak and a higher dynamic compliance, but PCV had a larger tidal volume and lower EtCO2. There were no differences in terms of abdominal and umbilicus pain, as well as hemodynamic parameters, between two groups.

Ultrasound-guided versus conventional peribulbar anaesthesia in cataract surgery: A randomised controlled study.

Blind ophthalmic anaesthetic techniques may have serious complications. To assess the safety of ultrasound as a guide in ophthalmic blocks. Fifty adult patients undergoing cataract surgery under peribulbar block anaesthesia were randomly assigned to ultrasound-guided and conventional block groups. In the ultrasound-guided block group, a large amount of the standard ultrasound gel was applied to the closed eyelids. The globes were scanned in both sagittal and transverse planes. The patients were asked to look straight ahead with closed eyes without clenching the eyelids. The depth and gain were adjusted before performing the block. The primary outcome was the rate of complications. Secondary outcomes included the volume of injected anaesthetics and surgeon and patients' satisfaction. The local anaesthetic volume used was not significantly different between the two groups (7.08 ± 1.66 and 6.72 ± 1.97ml). The block onset, time and quality were comparable in both groups. No complications were reported, and there were no significant differences regarding surgeons' or patients' satisfaction with either procedure. The ultrasound-guided local ophthalmic block is as safe as the conventional method. Although its use was not superior to the conventional procedure, direct visualisation with ultrasound may be important to avoid vulnerable structures such as staphylomas.

Efficacy of Retrobulbar versus Topical Anesthesia in Cataract Surgery

Aim: To monitor the effect of retrobulbar versus topical anesthesia in cataract surgery patients by comparing different parameters such as: intraocular pressure akinesia and analgesia parameters. Study type: Interventional case series. Place and duration of study: Department of Ophthalmology, Niazi Medical &amp; Dental College Sargodha from 1st October 2020 to 31st October 2021. Methodology: One hundred patients who underwent cataract surgery were enrolled. Study participants were divided into two groups and each group contain fifty 50 participants. Group one give retrobulbar block and group two treated by topical anesthesia. Complete ocular and systematic examinations and relevant examinations like clotting time, blood pressure, blood sugar, complete blood examination and bleeding time were done before starting the surgery. Results: 80% were males and 20% were females. During topical local anesthesia, 47(94%) patients experienced pain free surgery whereas in retrobulbar anesthesia, only 38(76%) patients experienced pain free surgery. In retrobulbar anesthesia group, complete akinesia was observed in 25(50%) patients. In retrobulbar group, significant increase in intraocular pressure was noted 41(82%) upto 30 mmHg after the administration of local anesthesia as compared to topical anesthesia group. Conclusion: Topical anesthesia is more safe and effective approach for cataract patients in contrast to retrobulbar group. It prevents many life and sight threatening implications like globe perforation and brain stem anesthesia. Key words: Efficacy, Retrobulbar, Topical anesthesia, Surgery

A survey of anaesthetic preferences in cataract surgery.

To identify current trends in anaesthesia technique for cataract surgery and make this information available to ophthalmologists. An electronic survey was created and distributed to members of online ophthalmology forums; results were subsequently analysed in spreadsheet software. In total there were 71 completed surveys. The most preferred anaesthesia technique in cataract cases was topical anaesthesia with intracameral injection (n=34, 47.9%), and the least preferred techniques were retrobulbar (n=1, 1.4%) and peribulbar blocks (n=1, 1.4%). The most commonly preferred local anaesthetic was lidocaine 2% (n=41, 57.7%). Topical anaesthesia techniques with lidocaine 2% appear to be the most preferred method of anaesthesia in cataract surgery in our survey. Compared with previous literature our survey shows that topical anaesthesia is being increasingly used in cataract surgery, especially in conjunction with intracameral injection. The predominant reasons for this seem to be patient comfort and ease of technique.

Non-Toxic Anesthesia for Cataract Surgery

Background: To study the safety and efficacy provided by a minimal and localized anesthesia in cataract surgery. Methods: Randomized controlled trial. A total of 100 patients undergoing cataract surgery were randomly divided into two groups of 50, which respecitvely received conventional topical anesthesia consisting of preservative-free Oxibuprocaine hydrochloride 0.4% drops or minimal localized anesthesia, administered with a cotton bud soaked in preservative-free Oxibuprocaine hydrochloride 0.4% applied to clear cornea on the access sites for 10 s immediately before surgery. The mean outcome measures were intraoperative pain and the incidence of postoperative ocular discomfort. Results: All patients tolerated well the procedure, giving patin scores between 1–3. Fifteen patients (30%) of group 1 and ten of group 2 (25%) required supplemental anesthesia. No intraoperative complications were recorded. No eyes had epithelial defects at the end of the surgery or at postoperative check-ups. Conclusions: Minimal anesthesia in cataract surgery resulted quick, safe and non-invasive.

Adjuvant ketorolac to peribulbar anesthesia in cataract surgery: a comparative study

Purpose The aim of this study was to evaluate the effect of adding ketorolac to peribulbar anesthesia versus conventional peribulbar anesthesia in cataract surgery. Patients and methods This is a prospective randomized comparative study that recruited patients with visually significant cataract and no other ocular or systemic conditions that may influence the ocular sensation. Patients were scheduled for phacoemulsification. They were randomly assigned into three groups. In the first group (GI), an anesthetic mixture of lignocaine, bupivacaine, hyaluronidase, and ketorolac was utilized. In the second group (GII), a mixture of lignocaine, bupivacaine, and hyaluronidase was used, whereas in the third group (GIII), a mixture of lignocaine, bupivacaine, and ketorolac was used. The onset of globe anesthesia and akinesia and the duration of globe akinesia were recorded. In addition, intraoperative pain and postoperative pain experienced by the participants were assessed using the numerical rating scale after patient instructions. Results The study included 114 patients. The onset of globe anesthesia was significantly faster in GI (6.5±1.3 min) compared with GII and GIII (8.1±1.5 and 8.8±1.9 min, respectively, P Conclusion Ketorolac was an effective adjuvant to peribulbar block. It effectively shortened the onset of globe anesthesia, with no significant effect on globe akinesia.

Patient preference and pain-reported outcomes for topical versus subtenon anesthetic for cataract surgery.

PURPOSE:Cataract extraction and lens implantation is the most common surgical procedure performed worldwide, with surgeons opting for either a topical or a subtenon anesthetic in majority of cases. While complication rates and pain scores have been previously examined in a bid to determine which modality was better, patients who have had both eyes operated upon under different techniques have never previously been asked which method they prefer. We undertook this study to fill in this crucial gap in our knowledge.METHODS:This is a retrospective study of patients who have undergone bilateral cataract surgery with one eye operated on with topical anesthesia and the other eye with subtenon anesthesia. Patients were identified who had had surgery undertaken in the previous 6 months at Singleton Hospital, Swansea, where both eyes had been operated upon using different anesthetic techniques. Telephone interviews with these patients were performed and their pain scores recorded on a scale from 0 (no pain) to 10 (severe pain) for both eyes, with the patients then being asked which the method of anesthetic they preferred. Statistical analysis of pain scores was compared using Wilcoxon rank-sum testing.RESULTS:One hundred and fifty-two patients in total were identified. One hundred and forty-one of the applicable patients participated in the study. Of these, 78 patients received topical anesthesia for their first operation and 63 had subtenon block for their first operation. The mean pain scores reported for surgery with topical anesthesia and subtenon block were 2.30 and 1.38, respectively. The pain data were analyzed using a Wilcoxon signed-rank test, returning a z-score of 4.038. This result therefore suggests that patients experience statistically significantly less pain from cataract surgery when given a subtenon block. Patients expressed a preference for subtenon anesthesia, with 70% preferring subtenon block, 23% preferring topical anesthesia, and 7% having no preference.CONCLUSIONS:Patients report less pain with subtenon anesthesia compared with topical anesthesia in cataract surgery, where both eyes were operated upon with different anesthetic techniques. This is the first study in which patients who have had both anesthetic techniques performed independently for cataract surgery have had their pain scores reported and statistically analyzed.

Safety and efficacy of adding different doses of neostigmine as an adjuvant in peribulbar block for cataract surgery: A randomized controlled trial

ABSTRACT Background: This study aimed to evaluate safety and efficacy of adding two different doses of neostigmine to the local anesthetic lidocaine in peribulbar block anesthesia for cataract surgery. Methods: This randomized, double blind, parallel group, controlled trial (Trial registration number: IRCT20210106049952N1) included 60 patients (30–70 years-old), ASA physical status I, II, or III who were scheduled for cataract surgery. Patients received standard peribulbar block (Group C) or standard block plus 0.25 mg neostigmine (Group N25) or 0.5 mg neostigmine (Group N50). All patients were assessed for primary outcomes including hemodynamics and onsets of motor and sensory blocks. Secondary outcomes included duration of block, patient’s and surgeon’s satisfaction, postoperative pain, and time to first analgesic dose. Results: Mean onset of motor block was significantly shorter in N25 and N50 groups (72.25 ± 20.3 and 44.3 ± 10.4 sec, respectively) than in control group (110.25 ± 35.6 sec). Onset of sensory block was significantly shorter in N50 group compared to control group as well as N25 group (P < 0.001). A significantly longer mean duration of block was observed in N50 group (173.55 ± 31.09 min) in comparison to control group (79.75 ± 12.51 min) and N25 group (81.25 ± 6.25 min). Mean time till first analgesic dose showed significant differences between the three groups C, N25, and N50 (2.85 ± 0.47, 3.45 ± 1.28, and 7.1 ± 1.25 h, respectively, P < 0.001). Only two patients belonging to N50 group developed postoperative nausea and vomiting. Conclusion: Neostigmine in 0.5 mg was superior to 0.25 mg dose when added to the local anesthetic lidocaine in peribulbar anesthesia for cataract surgery regarding both sensory and motor block as well as postoperative analgesia.

The effect of retrobulbar anesthesia for cataract surgery on the retinal nerve fiber layer thickness.

The aim of this study was to evaluate the effect retrobulbar and topical anesthesia on optic nerve by measuring retinal nerve fiber layer (RNFL) thickness before and after phacoemulsification cataract surgery using optical coherence tomography (OCT). A total of 126 eyes of 108 patients were included in the study. Retrobulbar anesthesia was used in 61 eyes of 53 patients, and topical anesthesia was used in 65 eyes of 55 patients. OCT scans were done 1week before the surgery and 4weeks after surgery, and the results were evaluated. The average RNFL thickness increased postoperatively in both groups (p < 0.001 for topical anesthesia group and p = 0.001 for retrobulbar anesthesia group). The preoperative and postoperative average and quadrant RNFL thickness and the change in RNFL thickness were not significantly different between the two anesthesia groups (p > 0.05). Our results suggest that retrobulbar anesthesia has no unfavorable effect on the retinal nerve fiber layer.

Comparision of desflurane and propofol for maintaining general anaesthesia in cataract surgery of elder patients

Objective To compare the application of desflurane and propofol as maintenance anesthetics to maintain intraoperative haemodynamics and quality of recovery in elder patients during cataract surgery. Methods After consent form obtained, 60 elder patients, from Jan.2017 to Dec.2017 scheduled for cataract surgery were randomized into 2 groups, 30 cases in each group.The desflurane group (D group) received desflurane inhalation and the propofol group (P group) received propofol using effect-site target-controlled infusion (TCI). The adequate depth of anaesthesia were monitored with narcotrend to ensure equipotency of anaesthetic administration in both groups. The Narcotrend Index maintained between 40 and 55 by titrating the anaesthetic agents. Cardiovascular drug intervention, the time of spontaneous breathing, the time of awakening and recovery adverse events were analysed. Results There was no difference of the time of spontaneous respiration or awakening between the two groups(P>0.05). The times of cardiovascular drug intervention in D group were fewer than that of P group (t=2.32, P=0.03). However, the adverse events of nausea and vomiting in lucid interval in D group were significantly more than those of P group (t=2.47, P=0.04). Conclusion Application of desflurane maintains general anaesthesia in elder patients during cataract surgery. There is no difference in spontaneous respiration or awakening between the two groups. However, desflurane inhalation anesthesia provides more stable haemodynamics during the operation. Propofol total intravenous anesthesia provides significantly better quality of recovery than desflurane inhalation anesthesia. Key words: Desflurane; Propofol; Cataract surgery, elder patients; General anaesthesia; Recovery

Peribulbar Block Using Dexmedetomdine versus Magnesium Sulphate as Additives to Local Anesthetics for Cataract Surgery

Background: peribulbar block is commonly used for cataract surgery in adults, most commonly local anesthetics were injected into peribulbar space, but using only local anesthetics for peribulbar anesthesia is associated with delayed onset of globe akinesia and, short duration of analgesia and frequent need of block supplementation Objective: to assess the efficacy and safety of addition of dexmedetomidine versus magnesium sulphate to local anesthetic mixture for peribulbar block in cataract surgery. Patients and Methods: the patients were divided randomly into two equal groups: Dexmedetomidine group (D Group) included 30 patients who received 50 µg dexmedetomidine adjuvant to local anesthetics mixture (lidocaine and bupivacaine). Magnesium sulphate group (M Group) included 30 patients who received 50mg of Magnesium sulphate adjuvant to local anesthetics mixture (lidocaine and bupivacaine). Results: The addition of Dexmedetomidine or Magnesium sulphate to local anesthetic in cataract surgery accelerates the onset of corneal anesthesia and globe akinesia . The decrease in the IOP is more in D Group . No significant changes in the hemodynamic measurements in both groups Conclusion: Use of 50ug dexmedatomedine or 50mg magnesium sulphate 10% with mixture of lidocaine 2% plus bupivacine 0.5% for peribulbar anesthesia in cataract surgery enhances the onset of globe anesthesia and akinesia . Dexmedetomidine causes more decrease in intraocular pressure magnesium sulphate.

Cataract Surgery under Local Anaesthesia - Search for Safer One

Background: Cataract surgery is usually done under local anaesthesia. But till now there are no absolutely safe local anaesthetics. Current study is done to find out a safer local anaesthetic for cataract surgery.Objective: To evaluate the onset, duration, quality, side effects and safety of bupivacaine and lignocaine in peribulbar block (PBB) for cataract surgery.Materials and method: This was a randomized observational controlled clinical study done in Monno Medical College Hospital, Manikganj, Bangladesh, in the period of October, 2014 to October, 2015. Two hundred cataract patients attending ophthalmology department were allocated to receive either 4 mL 0.5% bupivacaine+4 ml 2% lignocaine or 8 mL of 2% lignocaine for peribulbar block during cataract surgery. Onset, duration, quality of anaesthesia and after effects were used as a clinical parameter for the study.Results: Mean anaesthetic durations of lignocaine and bupivacaine+lignocaine were 75 minutes and 120 minutes respectively. Least complications were observed in subjects with lignocaine.Conclusion: Peribulbar blocks with 2% lignocaine provide better anaesthesia for cataract surgery and success rates are high without any complications. Anaesthetic time of lignocaine alone is enough for cataract surgeryDelta Med Col J. Jan 2018 6(2): 68-72

Efficacy of Preoperative Administration of Acetaminophen and Melatonin on Retrobulbar Block Associated Pain in Cataract Surgery.

BackgroundRetrobulbar block is one of the chosen methods for local anesthesia in cataract surgery. Since it is a painful procedure, using analgesic and sedative drugs is recommended. Current medications have side effects and evaluating of new drugs or new uses of existing safer drugs is necessary.ObjectivesThe aim of this study was to compare the administration of melatonin and acetaminophen on pain and hemodynamic changes during retrobulbar block.MethodsIn a double-blinded randomized trial, 180 patients undergoing cataract surgery were randomly divided into three groups: Melatonin group (received melatonin 6 mg), acetaminophen group (received acetaminophen 500 mg), and control group (received placebo). All drugs were administered orally 60 min before arrival to the operating room by nurses blinded to the drugs administered. All patients received fentanyl 0.5 μg/kg before retrobulbar block intravenously. Hemodynamic variables and pain score in each patient were evaluated on arrival in the operating room, during retrobulbar block, during surgery, 20 min after operation, at the end of surgery, and in the recovery room. In case of pain score more than three, additional fentanyl was administered. All data were recorded in structured data sheets.ResultsData analysis indicated no significant differences among the groups at baseline on any of the demographic variables. Both acetaminophen and melatonin reduced the pain score significantly compared with control during retrobulbar block (P < 0.05 and P < 0.01, respectively). Administration of additional fentanyl was significantly lower in the melatonin group than the control group (P < 0.05). Hemodynamic changes were not significantly different among all groups.ConclusionsFor the first time, as far as we have studied, the analgesic effect of acetaminophen on the retrobulbar block was indicated. We also showed that melatonin can reduce pain during retrobulbar block leading to reduction of additional fentanyl during operation. It seems that both melatonin and acetaminophen may have a beneficial effect on pain control in the retrobulbar block.

Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

PurposeTo determine the necessity of hyaluronidase as an anesthetic adjuvant for peribulbar anesthesia during cataract surgery and to assess differences in anesthetic outcomes in the absence of hyaluronidase. MethodsIn this double blinded randomized study, 202 patients reporting for surgery for senile cataract in their first eye under regional ocular anesthesia without pre-existing extra ocular movement restriction were randomly divided into 2 groups: Group 1 – anesthesia without hyaluronidase, Group 2 – anesthesia with 50 IU/ml Hyaluronidase. Peribulbar block with 5 ml of anesthetic mixture of 2% lignocaine with 1:200000 adrenaline and 0.5% bupivacaine with or without hyaluronidase was performed with 3 ml deposited in the infero-medial quadrant and 2 ml in the supero-medial quadrant followed by ocular massage. Surgeons’ score for akinesia, patients’ score for analgesia, augmentation of block if any and extra ocular movements on first post-operative day were compared between the groups. ResultsThere was no statistically significant difference between the two groups in akinesia (p = 0.22, 0.68 and 0.98), analgesia (p = 0.44 and 0.09) or requirement of anesthetic augmentation (p = 0.3). Extraocular movement restriction was not noted in any patient. Onset of akinesia and analgesia was earlier in Group 2 (p = 0.004 and p = 0.005 respectively). ConclusionsHyaluronidase is not an essential adjuvant for peribulbar block for cataract surgeries. Appropriate deposition of a smaller volume of anesthetic agent and adequate ocular massage provide adequate and safe anesthesia.

Anticoagulants and antiplatelet drugs during cataract surgery.

Patients undergoing cataract surgery are generally elderly, and many take drugs with systemic effects. The surgeon must be aware of the risks of continuing or discontinuing such medications perioperatively. Antiplatelet drugs and anticoagulants, prescribed to reduce the incidence of thromboembolic events, are often used in this population. This paper aims to review the perioperative use of antiplatelet and anticoagulant drugs in the setting of cataract surgery. Topical or intracameral anesthesia is preferred over anesthesia injected with needles. Aspirin can be safely continued in patients undergoing cataract surgery. Warfarin has been extensively studied, and the risk of hemorrhage associated with cataract surgery is low if the international normalized ratio is in the therapeutic range. Only a few studies of direct oral anticoagulants are available, and therefore no definite recommendations regarding those agents can be made at this time. Anesthesia in cataract surgery carries a low risk, even for patients taking anticoagulant or antiplatelet drugs. The discontinuation of this class of drugs before cataract surgery may increase the risk of thromboembolism.