Topical anaesthesia for phacoemulsification surgery

To assess the discomfort experienced by patients undergoing phacoemulsification under topical anaesthesia.

Thirty patients had a collagen contact lens, soaked in 4% lignocaine, placed on the cornea 23-89 min preoperatively. Immediately preoperatively, additional ophthetic drops were inserted. The patients underwent phacoemulsification surgery with the insertion of a foldable intraocular lens. This group was compared with 30 age- and sex-matched controls who underwent phacoemulsification and the insertion of a non-foldable lens under peribulbar anaesthesia. (8 mL of an 80:20 mix of 0.5% bupivacaine, 4% lignocaine and hyaluronidase). The pain perceived by patients was assessed on a verbal analogue scale (0-10) at administration of anaesthesia, perioperatively and 3-6 h postoperatively.

Topical anaesthesia was less painful than peribulbar anaesthetic at administration (difference in mean pain score 1.2, P < 0.05, Wilcoxon paired signed rank test). Patients experienced more pain during the operation under topical anaesthesia (difference in means 0.63, P < 0.05). There was no difference between the groups postoperatively.

Topical anaesthesia does not carry the risk of injection into, or injury of, the many delicate structures of the orbit. Because it provides acceptable levels of anaesthesia for phacoemulsification, it could be used more frequently.