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Oculocardiac reflex in phacoemulsification: Peribulbar vs topical anesthesia.

Prajakta Dandekar1, Sanil Mohan2, Vinod Baranwal3

  • 1Department of Ophthalmology, Military Hospital, Gwalior, Madhya Pradesh, India.

Indian Journal of Ophthalmology
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Phacoemulsification surgery under peribulbar block or topical anesthesia can cause oculocardiac reflex (OCR). Pain scores were significantly higher with topical anesthesia compared to peribulbar block.

Keywords:
Mean arterial pressureoculocardiac reflexperibulbartopical

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Area of Science:

  • Ophthalmology
  • Anesthesiology

Background:

  • Phacoemulsification is a common cataract surgery.
  • Anesthesia choice impacts patient comfort and physiological responses.
  • Oculocardiac reflex (OCR) is a potential complication during ocular procedures.

Purpose of the Study:

  • To compare vital parameters and pain during phacoemulsification under peribulbar block versus topical anesthesia.
  • To determine the incidence of oculocardiac reflex (OCR) in both anesthesia groups.

Main Methods:

  • A prospective, randomized study of 106 patients undergoing phacoemulsification.
  • Patients were divided into peribulbar block (Group PB, n=52) and topical anesthesia (Group TA, n=54) groups.
  • Mean arterial pressure (MAP), pulse rate, and pain (verbal analogue scale) were recorded; OCR was defined as a >20% pulse rate decrease.

Main Results:

  • Both anesthesia methods showed a trend towards increased MAP (P < 0.05).
  • Group TA exhibited a significant increase in pulse rate compared to baseline (P < 0.05).
  • OCR incidence was similar between groups (9 in PB vs. 11 in TA, P=0.687), but pain scores were significantly higher in Group TA (P < 0.0001).

Conclusions:

  • Oculocardiac reflex can occur with both peribulbar block and topical anesthesia during phacoemulsification, with no significant difference in incidence.
  • Topical anesthesia is associated with significantly greater patient-reported pain compared to peribulbar block.