Topical Anesthesia For Cataract Surgery Research Articles

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.

Anesthesia techniques and the risk of complications as reflected in the European Registry of Quality Outcomes for Cataract and Refractive Surgery.

To determine the trends in anesthesia techniques for cataract surgery over the past decade and their relationship to surgical complications. Clinics affiliated with the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). Retrospective cross-sectional register-based study. Variables include patient demographics, visual acuity, ocular comorbidities, surgery characteristics, intraoperative complications, and postoperative complications for the study period from January 2008, to December 2018. The anesthesia methods registered in the EUREQUO and included in the study are topical, combined topical and intracameral, sub-Tenon, regional, and general anesthesia. Multivariate logistic regression models for each complication were constructed to estimate the adjusted odds ratio (OR) and 95% CIs. Complete data were available of 1 354 036 cataract surgeries. Topical anesthesia increased significantly over time (from 30% to 76%, P < .001). Sub-Tenon and regional anesthesia decreased (from 27% and 38% to 16% and 6%, respectively, P < .001), and general and combined topical and intracameral anesthesia remained stable (around 2%). Sub-Tenon (OR, 0.80; 95% CI, 0.71-0.91, P < .001), regional (0.74; 95% CI, 0.71-0.78, P < .001), general (0.53; 95% CI, 0.50-0.56, P < .001), and intracameral anesthesia (0.76; 95% CI, 0.64-0.90, P = .001) carried a significantly decreased risk of posterior capsule rupture (PCR), with and without dropped nucleus, compared with topical anesthesia. The risk of endophthalmitis was significantly lower with regional anesthesia compared with topical anesthesia (OR, 0.60; 95% CI, 0.44-0.82, P = .001). The use of topical anesthesia for cataract surgery increased over time. Topical anesthesia is associated with an increased risk of PCR with and without dropped nucleus, and endophthalmitis.

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

Commentary: Improving the cataract surgery efficiency and clearing the cataract surgery backlog due to COVID-19 pandemic.

Commentary: Improving the cataract surgery efficiency and clearing the cataract surgery backlog due to COVID-19 pandemic.

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.

"Systemic Considerations in Monitored Sedation for Topical Anesthesia in Cataract Surgery"

"Systemic Considerations in Monitored Sedation for Topical Anesthesia in Cataract Surgery"

"Systemic Considerations in Monitored Sedation for Topical Anesthesia in Cataract Surgery"

"Systemic Considerations in Monitored Sedation for Topical Anesthesia in Cataract Surgery"

How does sub-Tenon's anesthesia compare with topical anesthesia for cataract surgery?

How does sub-Tenon's anesthesia compare with topical anesthesia for cataract surgery?

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.

Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques. Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status. We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery. We assessed trial quality and extracted data in the format allowing maximal data inclusion. We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically significant, was probably too small to be of clinical relevance. The quality of the evidence was rated as high for intraoperative pain and moderate for pain at 24 hours. We did find differences in pain during administration of local anaesthetic (low level of evidence), and indications that surgeon satisfaction (low level of evidence) and participant satisfaction (moderate level of evidence) were less with topical anaesthesia. There was not enough evidence to say that one technique would result in a higher or lower incidence of intraoperative complications compared with the other. Both topical anaesthesia and sub-Tenon's anaesthesia are accepted and safe methods of providing anaesthesia for cataract surgery. An acceptable degree of intraoperative discomfort has to be expected with either of these techniques. Randomized controlled trials on the effects of various strategies to prevent intraoperative pain during cataract surgery could prove useful.

CATARACT SURGERY

Objectives: To compare the effectiveness of topical and retobulbar anesthesiain term of pain relief in patients subjected to cataract surgery. Material and methods: Thiscomparative study was conducted at Department of Ophthalmology, Bahawal Victoria HospitalBahawalpur from 18th July, 2012 to 18th January, 2013. Total 100 patients with cataract wereincluded in this study. Results: Mean age of the patient was 64.14 ± 8.7 years. No. of patientsin RA group who reported the pain scores (0- 4) during cataract surgery, was 46 (effectivenesswas positive in 92% patients), while it was 33 (effectiveness was positive in 66% patients) in TAgroup. A significant difference between effectiveness of both anesthetic group was observed. (P= 0.001). Conclusion: It is observed that topical anesthesia in cataract surgery is a simple, safeand noninvasive technique but it cannot be proposed as a very good alternative to retrobulbaranesthesia in cataract surgery of all patients regarding its effectiveness interms of pain relief.

Topical anesthesia for cataract surgery: the patients' perspective.

Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group (P < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery.

Comparative efficacy of topical tetracaine solution versus lidocaine gel in cataract surgery

Comparative efficacy of topical tetracaine solution versus lidocaine gel in cataract surgery Roberto Bellucci1, Francesco Bellucci21Ophthalmic Unit, Department of Neurosciences, Hospital and University of Verona, Verona, Italy; 2Faculty of Psychology, University of Parma, Parma, ItalyBackground: Cataract surgery is mainly performed under topical anesthesia achieved either by tetracaine solution (0.5%&ndash;1.0%) or gel (0.5%), or by 2% lidocaine gel. This paper reviews the current knowledge about these two drugs, with special emphasis on a published prospective comparison between them.Methods: The main pharmacological aspects of topical anesthetic agents are summarized, explaining the difference between the ester (tetracaine) and the amide (lidocaine) compounds. Tetracaine is available as single-use eye drops, or as a multidose gel containing benzalkonium chloride, a preservative not contained in the multidose lidocaine gel. A literature search was performed, using &ldquo;tetracaine&rdquo;, &ldquo;tetracaine gel&rdquo;, &ldquo;lidocaine&rdquo;, &ldquo;lidocaine gel&rdquo;, &ldquo;lidocaine jelly&rdquo;, and &ldquo;cataract surgery&rdquo; as keywords, and compiling cross-references. A total of 25 studies were identified and included in this review. Of them, seven were uncontrolled studies describing different experiences with the drugs of interest, and 18 were controlled studies. Six studies directly compared tetracaine eye drops or gel with lidocaine gel before cataract surgery.Results: Both tetracaine solution and gel and lidocaine gel proved to be effective in providing analgesia before cataract surgery. Both drugs were comparable with needle injection anesthesia when intracameral lidocaine was added to topical treatment. Direct comparisons indicate better activity for tetracaine when used at the 1% concentration in single-dose units, or in the gel form at a 0.5% concentration. Patients showed a slight preference for the agent that caused the least discomfort when administered (lidocaine), while the surgical complication rate and the surgeon satisfaction were the same with either drug.Conclusion: Tetracaine solution and lidocaine gel were equally effective in providing topical anesthesia for cataract surgery in the published studies. Tetracaine was found to be better than lidocaine only if augmented by either increasing the concentration to 1% (solution) or by increasing the penetration by adding benzalkonium chloride (gel).Keywords: tetracaine, tetracaine gel, lidocaine, lidocaine gel, cataract surgery

Tetracaine 0.5% eyedrops with or without lidocaine 2% gel in topical anesthesia for cataract surgery

To evaluate the level of pain during phacoemulsification and foldable intraocular lens implantation under instillation of tetracaine 0.5% eyedrops versus a combination of lidocaine 2% gel and instillation of tetracaine eyedrops. This prospective, randomized, controlled study included 51 patients undergoing phacoemulsification under topical anesthesia. They were randomized into two groups based on the topical anesthetic method they were to receive. Preoperatively all patients were asked to answer a questionnaire. One hour postoperatively, they were asked to grade their intraoperative and postoperative pain on a visual analog scale from 0 to 10. There were no statistically significant differences between the two methods of anesthesia. Gender and the presence of relatives or friends were independent factors playing a significant role in pain sensitivity. The combination of lidocaine 2% gel and tetracaine eyedrops does not have a better analgesic result than a single instillation of tetracaine 0.5% eyedrops.

Asymptomatic oculocardiac reflex during phacoemulsification

Editor, The oculocardiac reflex (OCR) is defined by the appearance of bradycardic arrhythmia and reduced arterial pressure and may be associated with a symptomatic vagal response consisting of nausea and vomiting. The OCR may be elicited by pressure on the globe – as occurs in acute glaucoma (Faupel & Niedermeier 1970) and extracapsular cataract surgery (Gao et al. 1997) – among other causes. The purpose of this study is to assess the appearance of OCR during phacoemulsification. A prospective, interventional study was performed on 122 consecutive patients who were operated on by uneventful phacoemulsification. Written informed consent was obtained from the patients prior to the procedure and data gathering. The procedures were performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Three different modalities of anaesthesia [peribulbar blockade (PB), topical anaesthesia (TA) and topical + anterior chamber anaesthesia (TACA)] were used depending on the preferred clinical practice of each of the surgeons. PB was performed by injection of 3 ml 2% lidocaine and 3 ml 0.5% bupivacaine; TA was performed by the instillation of tetracaine 0.5% in the conjunctival cul de sacs. TACA was performed as TA plus 0.1 ml 2% lidocaine in the anterior chamber. The patients were operated on by ‘divide and conquer’ phacoemulsification and were monitored during surgery by chest electrodes. The heart rate (HR) was determined immediately before surgery (basal) and 10 seconds after starting continuous anterior chamber infusion at 95 cm H2O (≈ 70 mmHg). OCR was defined by a decrease in HR greater than 15% from baseline (Karanovic et al. 2006). The concomitant medical treatment given prior to surgery and during surgery was registered. Sixteen patients were operated on under PBA, 39 patients under TACA and 67 patients under TA. The results are shown in Table 1. The HR in the whole group decreased from an average 71.3 ± 11.3 beats per minute (bpm) to 68.9 ± 12.3 bpm (p= 0.0006); a reduction ≥ 15% was observed in 19 patients from an average 71.4 ± 9.4 to 58.4 ± 7.5 bpm (p< 0.001; Student’s t-test for paired data). Considering the different modalities of anaesthesia, OCR appeared in 1/15 patients under PB and in 3/40 patients under TACA, compared with 15/67 patients under TA (t = 2.26, p= 0.03, simple linear regression). OCR appeared more frequently among patients older than 75 years (t = 2.65, p= 0.01, simple linear regression). A symptomatic vagal response in the form of nausea and vomiting did not appear in any case. None of the patients required pharmacological treatment or change in the surgical schedule. Since the first reports on the use of topical anaesthesia for cataract surgery were published (Kershner 1993), a trend towards a widespread indication of topical anaesthesia exists. However, we should be aware that phacoemulsification with TA is more painful than with PBA and that the effect of pain may induce changes in systemic objective parameters such as white blood cell count, cortisol levels and systemic arterial pressure (Gombos et al. 2007). Different combinations of anaesthetic drugs have reported either for PB blockade (Borazan et al. 2008) or as a combination of topical plus peribulbar anaesthesia (Monteiro et al. 2007). Modern cataract surgery involves sudden rises and drops in intraocular pressure (IOP) (95 cm H2O ≈ 70 mmHg), which might be associated with a decreased HR or other vagal signs. Pain may also play a role in the appearance of OCR, and increased analgesia may reduce the frequency of OCR in patients undergoing retinal surgery (Vlajkovic et al. 2007) – although opioids may induce OCR (Snellen et al. 1993). In our study, fentanyl did not seem to influence the changes in HR. Symptomatic OCR was not detected in any patient in our series, which may explain why the appearance of OCR has not been reported during phacoemulsification previously. We would like to alert cataract surgeons of a potential risk of bradycardia in older patients (especially when performing topical anaesthesia in outpatient non-hospital settings). Further studies assessing changes in HR are required in order to determine the effect of IOP rises during phacoemulsification.

Comparative study of topical anaesthesia with lidocaine 2% vs levobupivacaine 0.75% in cataract surgery

This study compared the efficacy of topical anaesthesia with levobupivacaine 0.75% vs lidocaine 2% during cataract surgery by phacoemulsification. A prospective, randomized, double-blind study comparing two agents for topical anaesthesia in cataract surgery. Two hundred and forty-six consecutive patients undergoing corneal phacoemulsification were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=126) or lidocaine 2% (n=120). The main outcome variables of the study were intraoperative and postoperative pain, requirement for additional anaesthesia, patient comfort and cooperation, surgeon satisfaction, and corneal epithelial toxicity induced by topical drugs. evobupivacaine 0.75% provided significantly better analgesia than lidocaine 2% during cataract surgery (P<0.001) at the end of surgery (P<0.002), and up to 30 min after surgery (P<0.001). There were no statistically significant differences between the two groups 5 h after surgery. Epithelial toxicity was similar in both groups, and patient comfort and surgeon assessment of patient cooperation were better in the levobupivacaine group. Topical anaesthesia with levobupivacaine 0.75% was more effective than lidocaine 2% in preventing pain and improving patient and surgeon comfort during cataract surgery, with similar toxicity.

Mydriasis with different preparations of topically administered lidocaine hydrochloride

To quantify the mydriatic effect and side effects of topical lidocaine hydrochloride with different pH values and concentrations in healthy volunteers. Umeå University Hospital Eye Clinic, Umeå, Sweden. In this intraindividual comparison double-masked randomized study, healthy volunteers were given topical lidocaine 8%, lidocaine 8% pH 6.0, or a placebo 3 times at 90-second intervals. Thereafter, a drop of tropicamide 0.5% or placebo was given (tropicamide setting). Another group of healthy volunteers was given topical lidocaine 4%, 8%, or 16% 3 or 6 times at 90-second intervals (dose-response setting). Before and 15, 30, 60, and 180 minutes after eyedrop instillation, the near point was determined and Scheimpflug photography was performed. The tropicamide setting comprised 26 volunteers (mean age 23.5 years) and the dose-response setting, 10 volunteers (mean age 24.5 years). The direct mydriatic effect of lidocaine was larger at pH 6.0 (mean peak effect 0.61+/-0.06 [SEM] versus 0.42+/-0.04 mm) (P< .05), and the augmentation of tropicamide mydriasis was larger at pH 6.0. Lidocaine 8% had a better direct mydriatic effect than lidocaine 4% and lidocaine 16% (mean peak effect 0.60+/-0.09 mm versus 0.19+/-0.08 mm and 0.28+/-0.10 mm, respectively) (P< .01). Lidocaine 16% given 6 times caused corneal side effects. Lidocaine 8% with pH 6.0 had a maximum direct mydriatic effect and gave maximum augmentation of tropicamide mydriasis without causing unwanted corneal side effects and thus should be preferable for topical anesthesia in cataract surgery.

Comparing Retrobulbar and Topical Anaesthesia in Cataract Surgery by Phacoemulsification – How Can Patient Comfort During Surgery by Phacoemulsification Be Improved?

The first section of this article is a summary of the development of cataract surgery and the anaesthetic methods used in cataract surgery. When comparing the effectiveness of retrobulbar anaesthesia (RBA) and topical anaesthesia (TA), we found that more patients in the TA group indicated pain during the procedure (p&lt;0.001). After analysing pre-operative data, we could predict which patients would report intraoperative pain with 93% certainty. The type of anaesthesia and the skills of the surgeon are robust factors, while higher levels of stress hormones before surgery are also significant, especially in younger patients. The possible origin of pain and the role of positive verbal communication around the procedure are discussed. In order to prevent unexpected surgical situations, it is better to offer patients the most appropriate method of anaesthesia rather than using a ‘one size fits all’ solution.

Viscous tetracaine hydrochloride 0.5% for topical anesthesia in cataract surgery

For the past decade, lidocaine 2% gel has been one of the more commonly used agents for topical anesthesia in cataract surgery, particularly in the USA. Given its prolonged contact time with the ocular surface by nature of its viscosity, it has been found to provide superior anesthesia relative to anesthetic drops. A downside to this inexpensive and efficacious agent is that it was never intended to be used for ophthalmic surgery and, as a result, is packaged in a tube rendering it somewhat messy to apply. TetraVisc™ is a high-viscosity formulation of tetracaine hydrochloride 0.5% that is packaged in a sterile ophthalmic dropper bottle. A single report in the literature suggests that it is of equal efficacy to lidocaine 2% gel as a topical anesthetic for routine cataract surgery.

Frühe visuelle Rehabilitation nach Kataraktoperation in kombinierter topischer und intrakameraler Anästhesie

Topical anaesthesia in cataract surgery permits early visual rehabilitation due to the reduced impact on the optic nerve function. In this prospective study, we evaluated the course of visual improvement after surgery. 45 consecutive patients with senile cataract and no concomitant eye disease were included in the study. Cataract surgery by clear corneal phacoemulsifaction was performed with insertion of a foldable IOL in the capsular bag under topical anaesthesia. For anaesthesia topical lidocaine gel (2 %) and intracameral injection of 0.15 ml lidocaine (1 %) was used. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were measured in decimal fractions within 4 hours after surgery and 1 day postoperatively. The average preoperative UCVA was 0.23 +/- 0.39 and BCVA was 0.38 +/- 0.23 SD. Four hours postoperatively UCVA and BCVA improved significantly to 0.48 +/- 0.24 and 0.68 +/- 0.18, respectively. One day after surgery, the average UCVA was 0.65 +/- 0.15 and the BCVA was 0.89 +/- 0.07. 75 % (34) of the patients improved to a UCVA of 0.5 or better. The visual acuity improved in all patients one day after surgery, with 60 % (27) of the patients achieving a BCVA of 0.9 or better one day postoperatively. The postoperative corneal function had a significant influence on visual recovery (p = 0.01). A significant visual improvement was observed immediately after cataract surgery using the combination of topical and intracameral anaesthesia. 75 % of the patients reached a UCVA, which permitted sufficient visual function for mobility and orientation. Thus, the rapid recovery of visual function suggests an increased safety, particularly for out-patient surgery.

Levobupivacaine 0.75% vs. lidocaine 4% for topical anaesthesia

The aim of this study was to compare the efficacy of topical levobupivacaine drops 0.75% vs. lidocaine drops 4% in cataract surgery. We examined 203 patients undergoing cataract surgery by phacoemulsification. They were randomized into two groups: one received four drops of lidocaine 4% and the other received four drops of levobupivacaine 0.75%. The onset and offset times of sensory block were evaluated. Application, intraoperative and postoperative subjective pain was quantified by the patients using a verbal pain score. Complications, rates of supplemental anaesthesia, and the satisfaction of surgeon and patients were also recorded. The mean sensory onset and offset times were significantly higher for the levobupivacaine group (P < 0.01). Pain score was lower in the levobupivacaine group than in the lidocaine one and the difference was statistically significant at all stages (P < 0.01). The mean satisfaction scores of patients and surgeon were also statistically higher for levobupivacaine (P < 0.01). No significant differences for complications and rates of supplemental anaesthesia were found. Topical levobupivacaine 0.75% shows the same efficacy and safety as lidocaine 4% in cataract surgery by phacoemulsification. There was an adequate block with a good level of satisfaction of surgeon and patients. Levobupivacaine 0.75% offers a new and acceptable choice for topical anaesthesia in cataract surgery.