Combined topical-peribulbar anesthesia for cataract surgery

Area of Science:

• Ophthalmology
• Anesthesiology
• Surgical Procedures

Background:

• Peribulbar anesthesia is commonly used for ophthalmic surgeries.
• Optimizing anesthetic techniques is crucial for patient comfort and surgical outcomes.
• Low-volume techniques aim to minimize complications associated with traditional peribulbar injections.

Purpose of the Study:

• To assess the anesthetic efficacy of a single-point, low-volume peribulbar injection supplemented with topical anesthesia.
• To evaluate patient comfort and safety during phacoemulsification and intraocular lens implantation.
• To determine the impact on intraoperative and postoperative parameters.

Main Methods:

• A prospective study of 500 consecutive patients undergoing cataract surgery.
• Administration of 4 cc lidocaine 2% with hyaluronidase as a single-point peribulbar block.
• Supplementation with topical lidocaine 4% drops.
• Evaluation of intraoperative akinesia, lid closure, and anesthesia.
• Postoperative assessment for pain, discomfort, foreign-body sensation, diplopia, and lid closure.

Main Results:

• No to mild intraoperative pain reported by all patients.
• Adequate akinesia achieved in 92% of patients (34% total, 58% partial).
• Subconjunctival hemorrhage occurred in 12% of patients.
• Postoperative foreign-body sensation in 42%, diplopia in 32% (transient), and ptosis in 58% (transient).

Conclusions:

• Single-point low-volume peribulbar anesthesia with topical supplementation is safe and effective for ophthalmic surgery.
• The technique provides good intraoperative anesthesia and akinesia.
• It facilitates early visual recovery, with topical therapy manageable postoperatively.