Efficacy Of Peribulbar Anaesthesia Versus Topical With Intracameral Lignocaine Anaesthesia In Manual Small Incision Cataract Surgery: A 1-Year Randomized Controlled Trail

Abstract

INTRODUCTION AND AIMS: Cataract is most common treatable cause of blindness in elderly population . The only treatment available is cataract surgery.Anesthesia is an important part of the cataract surgery which aims at creating a comfortable environment for the patient and surgeon during surgery and quick recovery of function without added risks. This study was done to study the efficacy of peribulbar anesthesia versus topical with intracameral lignocaine anesthesia in manual small incision cataract surgery. To compare surgeon’s experience during surgery under both technique and to evaluate surgical outcome in both groups. METHODS: The present study of randomized controlled trail was conducted at KLES Dr. Prabhakar Kore Hospital and MRC Belgaum from January 2012 to December 2012. The study was approved by the ethical and research committee. One twenty patients undergoing cataract surgery were randomized into two groups(60 each).Group one was peribulbar anaesthesia and group two was topical with intracameral anaesthesia. Patients with cataract and age more than 50 years were included in the study.Un – cooperative patients, corneal dystrophies/ degenerations ,one eyed patient were excluded. Informed written consent was obtained from all the patients for the anesthetic procedure and surgery. Detailed history and ocular examination was done preoperatively. Group one patients were administered peribulbar block and Group two patients were administered topical lignocaine jelly preoperatively and preservative free 1% lignocaine intracameral intraoperatively. Parameters studied in both the groups were akinesia,analgesia and complications occurring during administration of anaesthesia; surgeon’s experience was evaluated in terms of patient’s cooperation, difficulty while doing surgery due to ocular movements ,anterior chamber stability,time taken to complete surgery; surgical outcome was studied with regards to any complications during surgery,best corrected visual acuity at 6 weeks. Statistical analysis was done using chi-square test. . Statistical correlations were done by SPSS statistical data package editor, version 12.0 RESULTS: One twenty patients were included. Mean age was 64.5 years. Males were 54.17% and females were 45.83%. Lid akinesia was 96.66% and globe akinesia was 100% which were seen only in peribulbar group and lacked in topical group which was statistically significant (p<0.001).No major vision or life threatening complications occurred in both the groups while administration of anesthesia. Minor complications such as chemosis(45% ) and subconjunctival haemorrhage (21.66% ) was statistically and clinically significant (p<0.001) where exclusively seen in peribulbar group. Corneal abrasion (3.33%), giddiness (5%) which were not significant (p=0.242) were seen only in peribulbar group. Surgical step during which pain occurred was scleral incision, tunneling, cortical wash which was statistically significant in topical group. Surgical complications like posterior capsular rent without vitreous loss occurred in (3.33%) in peribulbar group and (1.66%) in topical group which was not significant (p=1.000).No other significant complications occurred while surgery. Pain scale between both the groups showed no significant difference (p=0.226) immediately after surgery. Pain scale was significant in peribulbar group after 4hrs of surgery (p<0.001).Patient cooperation and lesser ocular movements during surgery was better in peribulbar group (p<0.001). Anterior chamber stability was similar in both the groups (p=0.266). Best corrected visual acuity 6 weeks post operatively showed no significant difference in both the groups (p=0.324) and 56.7% had 6/9 visual acuity. CONCULSION: Peribulbar anesthesia provides excellent akinesia which lacks in topical anaesthesia. Needle related complications do occur in peribulbar anesthesia which is eliminated by topical anaesthesia. Analgesia provided is similar under both the techniques. Patient’s cooperation and difficulty due to ocular movement is better in peribulbar anesthesia as experienced by surgeon .In our study,both the techniques were free from vision or life threatening complications and had no difference in best corrected visual acuity. Topical with intracameral anaesthesia can be an alternative to peribulbar anaesthesia for manual small incision cataract surgery provided the patient is very cooperative.