Topical anesthesia versus retrobulbar block for cataract surgery: the patients' perspective

To compare patients' perception of topical anesthesia (TA) with combined peribulbar and retrobulbar block (PRBB) for cataract surgery.

Prospective, randomized, controlled, cross-over observational study.

Private clinic.

98 ASA physical status I and II patients presenting for bilateral cataract surgery 1 week apart.

Patients were prospectively randomized to receive either TA for surgery to one eye, followed by PRBB for surgery to the other eye 1 week later, or to receive PRBB first, followed by TA for the second operation the following week. Surgery, PRBB, and TA were standard for all cases. Interviews were conducted the day following surgery by an unbiased observer unaware of the technique used. Surgical pain was estimated on a visual analog scale of 0 to 10, and the surgeon judged the difficulty of surgery based on patient compliance and cooperation on a scale of 0 to 5. Means and variance of results were compared with analysis of variance.

Mean age was 71.45 +/- 9.76 years (mean +/- SD). Seventy patients (71.43%) preferred PRBB while 10 patients (10.20%) preferred TA (p = 0.0001). Eighteen patients (18.37%) reported no difference between the two techniques. Ninety-six patients (97.96%) were not aware of the PRBB being injected. Duration of surgery was similar for TA (11.92 +/- 3.43 min) and PRBB (10.78 +/- 3.00 min; p = 0.06). Surgery was more difficult during TA (p = 0.0004). Pain was worse during TA (p = 0.0001). Surgical and anaesthetic complications were unremarkable for both techniques.

Patients who experienced both TA and PRBB preferred PRBB.