Pain in scleral pocket incision cataract surgery using topical and peribulbar anesthesia

To evaluate the pain produced during different phases of phacoemulsification cataract surgery using a scleral pocket incision under topical versus peribulbar anesthesia.

Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.

This prospective study comprised 100 cataract patients who were randomly selected to have phacoemulsification with a scleral pocket incision using either topical or peribulbar anesthesia. Topical anesthesia comprised oxybuprocaine 0.4% drops. Peribulbar anesthesia was given with an inferolateral transconjuctival injection of an even mixture of lidocaine 2% and bupivacaine 0.5% with hyaluronidase. Inadvertent eye movement during surgery was recorded. Pain occurring during intravenous line cannulation, introduction of the anesthetic agent, and phacoemulsification was measured using a visual analog scale (from 0 to 10) and a descriptive verbal 5-step scale. Patients were asked about pain immediately after each phase.

The pain during cannulation was similar in both groups (P = .498). The peribulbar injection was statistically significantly more painful than induction of topical anesthesia (2.11 and 0.10, respectively; P < .001). Surgery was statistically significantly more painful in the topical group than in the peribulbar group (2.76 and 0.85, respectively; P < .001). The mean pain score during all 3 phases was similar (1.43 topical group and 1.51 peribulbar group; P = .500). On the verbal scale, surgery was more painful under topical than under peribulbar anesthesia (P < .001). There were no statistical differences in pain during the peribulbar injection and during cannulation (P = .461 and P = .462, respectively). Inadvertent eye movement occurred more often in the topical anesthesia group.

Considering the entire procedure, total pain using topical anesthesia was acceptable and equal to that using peribulbar anesthesia for phacoemulsification with a scleral pocket incision. Pain during phacoemulsification was greater under topical anesthesia but not significantly different from the pain during the peribulbar injection.