A Comparison Of Topical And Peribulbar Anaesthesia In Phacoemulsification With Intraocular Lens Implantation To Evaluate Patient And Surgeon Satisfaction: A Randomised Clinical Trial

Abstract

Introduction: Cataract is a major cause of visual disability worldwide. Cataract surgery has undergone significant changes beginning with the abandonment of intracapsular surgery, and continuing with the advent of intraocular lenses. Phacoemulsification is widely practiced as modern day cataract surgery with fast visual recovery. Local anesthesia has also evolved in the course to reduce orbital complications and systemic side effects. It is also important to consider patient and surgeon comfort without compromising safety and outcome of the surgery. This study was done to compare the efficacy of peribulbar with topical anaesthesia in phacoemulsification by quantitative assessment of both patient and surgeon satisfaction. Materials and Methods: This prospective randomized study comprised 160 patients who underwent phacoemulsification with intraocular lens implantation. Patients were randomised into two groups, 80 in each group.Group A received peribulbar anesthesia of lignocaine 2% with adrenaline. Another group B received topical anaesthesis of proparacaine hydrochloride 0.5%. Evaluation of patient’s satisfaction is done using verbal pain score to measure pain intensity at the end of the surgery and 4 hours after the surgery. Evaluation of surgeon satisfaction was done at the end of the procedure based on patient’s co-operation and ease of surgery. Intraoperative and postoperative complications were also recorded. Results: The mean age of study group was 63.37 years. Out of 160 patients,98 (61.25%) were male and 62(38.75%) were female. Lid akinesia and globe akinesia was seen in 95% and 96.25% of patients in group A (p<0.001).Complications during administration of anaesthesia in group A were chemosis (18.75%), subconjunctival haemorrhage (15%) and giddiness (7.5%) was statistically significant (p<0.001) in comparison with group B. Intraoperative complications as endothelial touch 3.75% in group A and 2.5% in group B (p=0.4)and PC rent without vitreous loss 2.5% in group A and 3.75% in group B (p>0.2). Intraoperative pain in group A and group B ocurred during iridal contact (3.75%; 2.5%), intraocular lens implantation (2.5%;2.5%) , pain during irrigation and aspiration (3.75%:2.5%) with p value 0.4,>0.2and 0.4 respectively. Pain assessment immediately after surgery was 16.25% (group A) and 8.75% (group B) had tolerable pain (p>0.0415). Pain assessment after 4 hours of surgery was 81.25% and 95% had grade I(tolerable pain) in both groups A and B respectively(p>0.2).6.25% in group A and 1.25%in group B had grade 2 pain (p=0.11).Surgeon experienced grade 1 difficulty in 2.5% in group A and 2.5% in group B(p=0.5) rest all cases were grade 0.Surgeon graded patient’s co-operation as excellent(grade 0) in group A (97.50%) and group B (93.75%).There was no significant difference in patient reported pain scores, surgeon’s assessment of patient cooperation and intraoperative complications among two groups. CONCLUSION In this study, topical anesthesia provided good patient satisfaction and it was comparable to satisfaction achieved using peribulbar anesthesia. The speed and ease of administering topical anesthesia with lower incidence of complications associated with it, makes topical anesthesia suitable and safe choice for phacoemulsification surgery.