Effectiveness of sub-Tenon's versus peribulbar anesthesia in extracapsular cataract surgery

To compare the effectiveness of sub-Tenon's versus peribulbar anesthesia in extracapsular cataract surgery.

Department of Ophthalmology and the Maccabi Eye Institute, Tel Aviv, Israel.

Sixty-four consecutive patients who had extracapsular cataract surgery were randomized to have sub-Tenon's or peribulbar anesthesia. Intraocular pressure (IOP) was measured before and 1 and 10 minutes after injection. The motility of the rectus muscles was evaluated before and 20 minutes after the injection, and the patient's anxiety level was recorded immediately after the injection. Pain was assessed intraoperatively and 1 and 24 hours postoperatively by patient self-grading.

One minute after the injection, IOP increased significantly in the peribulbar group (mean 7.97 mm Hg +/- 8.80 [SD]) (P < .05). There was no significant increase in the sub-Tenon's injection group (mean 0.12 +/- 3.09 mm Hg). In both groups, IOP returned to preinjection levels by 10 minutes postoperatively. Patients with peribulbar anesthesia reported a significantly higher level of anxiety than those who had sub-Tenon's anesthesia (P < .05). Although the intraoperative pain levels were the same, the sub-Tenon's group reported significantly higher levels of pain 1 and 24 hours postoperatively; 16% in the sub-Tenon's group and none in the peribulbar group reported moderate pain 24 hours after anesthesia. Ocular motility was the same except for the inferior rectus muscle, which was less motile on average in the peribulbar group.

Sub-Tenon's anesthesia led to less IOP elevation than peribulbar anesthesia and provided similarly good globe immobilization and approximately the same pain levels intraoperatively.